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General NPI Number Information
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NPI Number | 1730479890
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Entity Type | Organization
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Legal Business Name | CAPTURA 22, INC.
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 9013 NE HIGHWAY 99 STE Q
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City | VANCOUVER
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State | WA
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Zip | 98665-8943
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Country | US
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Telephone | 360-718-8276
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Fax | 360-885-1565
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Provider Business Mailing Address
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Address Line | 9013 NE HIGHWAY 99 STE Q
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City | VANCOUVER
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State | WA
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Zip | 98665-8943
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Country | US
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Telephone | 360-718-8276
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Fax | 360-885-1565
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. DEBI DIANE KYLE
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Credential |
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Telephone | 360-718-8276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | IHSFS60203382
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License Number State | WA
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