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General NPI Number Information
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NPI Number | 1174318893
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Entity Type | Organization
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Legal Business Name | CAPSTONE NGMC LLC
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Dates
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Enumeration Date | 04/12/2025
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 1644 CHENEY LANE 1644 CHENEY LANE
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City | HAYWARD
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State | CA
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Zip | 94545-4331
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Country | US
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Telephone | 510-670-0239
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Fax | 510-784-0294
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Provider Business Mailing Address
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Address Line | 1224 S JACK TONE RD
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City | RIPON
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State | CA
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Zip | 95366-9352
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Country | US
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Telephone | 510-589-6705
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. NATHANIEL FRANCO CORRO
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Credential |
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Telephone | 510-589-6705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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