MEDICARE: CAPSTONE HEALTHCARE,L.L.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1124781703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPSTONE HEALTHCARE,L.L.C

Provider Business Mailing Address
First Line	:	1001 GREAT OAKS DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-3124
Country	:	US
Telephone Number	:	386-492-5635
Fax Number	:	386-246-7418

Provider Business Practice Location Address
First Line	:	1001 GREAT OAKS DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-3124
Country	:	US
Telephone Number	:	386-492-5635
Fax Number	:	386-246-7418

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ROSHANDA K. IVEY
Credential	:	APRN, FNP-C
Telephone Number	:	386-334-0095

Provider Enumeration Date	:	10/20/2021
Last Update Date	:	10/20/2021

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