Provider Demographics
NPI: | 1063003929 |
---|---|
Name: | CAPRICORN HEALTH LLC |
Entity Type: | Organization |
Organization Name: | CAPRICORN HEALTH LLC |
Other - Org Name: | CAPRICORN HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANAGING MEMBER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHRISTOPHER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GELMANN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 443-553-0057 |
Mailing Address - Street 1: | 101 CHESAPEAKE BLVD STE B |
Mailing Address - Street 2: | |
Mailing Address - City: | ELKTON |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21921-6607 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2327 PULASKI HWY STE 103 |
Practice Address - Street 2: | |
Practice Address - City: | NORTH EAST |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21901-3706 |
Practice Address - Country: | US |
Practice Address - Phone: | 443-877-6648 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CAPRICORN HEALTH LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2021-02-02 |
Last Update Date: | 2021-02-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207QA0401X | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | Group - Multi-Specialty |