Provider Demographics
NPI:1093580615
Name:CAPSTONE-PERRYTON OPCO LLC
Entity Type:Organization
Organization Name:CAPSTONE-PERRYTON OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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 1:3101 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-5345
Mailing Address - Country:US
Mailing Address - Phone:806-435-5403
Mailing Address - Fax:
Practice Address - Street 1:3101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-5345
Practice Address - Country:US
Practice Address - Phone:806-435-5403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility