Provider Demographics
NPI:1326139023
Name:CAPITOL HOME CARE NETWORK INC
Entity Type:Organization
Organization Name:CAPITOL HOME CARE NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:401-941-0002
Mailing Address - Street 1:400 RESERVOIR AVE
Mailing Address - Street 2:SUITE L-LN
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-3565
Mailing Address - Country:US
Mailing Address - Phone:401-941-0002
Mailing Address - Fax:401-941-0082
Practice Address - Street 1:400 RESERVOIR AVE
Practice Address - Street 2:SUITE L-LN
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-3565
Practice Address - Country:US
Practice Address - Phone:401-941-0002
Practice Address - Fax:401-941-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHNC02213251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI5854-2OtherBLUE CROSS RI PROVIDER NU
RI402560OtherBLUE CHIP RI PROVIDER NUM
RI4107045Medicaid
RI417045Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER