Provider Demographics
NPI:1033401963
Name:CAPITAL HOSPICE
Entity Type:Organization
Organization Name:CAPITAL HOSPICE
Other - Org Name:CAPITAL CARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:KESTENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-957-1888
Mailing Address - Street 1:3180 FAIRVIEW PARK DR STE 500
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-4583
Mailing Address - Country:US
Mailing Address - Phone:703-957-1764
Mailing Address - Fax:
Practice Address - Street 1:3180 FAIRVIEW PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-4583
Practice Address - Country:US
Practice Address - Phone:703-957-1764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1857251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491500OtherMEDICARE
VA=========OtherTAX ID