MEDICARE: CAPTOR USA INC

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	:	1922839430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPTOR USA INC

Provider Business Mailing Address
First Line	:	4014 PRAIRIE GROVE DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3920
Country	:	US
Telephone Number	:	201-456-3103
Fax Number	:	718-433-9002

Provider Business Practice Location Address
First Line	:	4014 PRAIRIE GROVE DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3920
Country	:	US
Telephone Number	:	201-456-3103
Fax Number	:	718-433-9002

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	IFTEKHAR AHMED
Credential	:
Telephone Number	:	201-456-3103

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

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