Provider Demographics
NPI:1003279928
Name:CAPSTONE VM HOLDINGS LP
Entity Type:Organization
Organization Name:CAPSTONE VM HOLDINGS LP
Other - Org Name:GRACE CARE CENTER AT VETERANS MEMORIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-712-6025
Mailing Address - Street 1:1424 FALLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77038-1846
Mailing Address - Country:US
Mailing Address - Phone:346-754-5070
Mailing Address - Fax:281-741-0355
Practice Address - Street 1:1424 FALLBROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77038-1846
Practice Address - Country:US
Practice Address - Phone:346-754-5070
Practice Address - Fax:281-741-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145129314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001027823Medicaid
TX001027823Medicaid