Provider Demographics
NPI:1346524485
Name:INT-CAP SERVICES
Entity Type:Organization
Organization Name:INT-CAP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:
Authorized Official - Last Name:NNAJI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-375-3535
Mailing Address - Street 1:3020 GLOXINIA RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7044
Mailing Address - Country:US
Mailing Address - Phone:704-375-3535
Mailing Address - Fax:704-332-9890
Practice Address - Street 1:230 W 24TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2635
Practice Address - Country:US
Practice Address - Phone:704-375-3535
Practice Address - Fax:704-332-9890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERCARE HEALTH SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3461251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3419053Medicaid