Provider Demographics
NPI:1376930453
Name:CAPITOL CARE INC.
Entity Type:Organization
Organization Name:CAPITOL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FISCAL
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:FRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-945-6941
Mailing Address - Street 1:185 STATE ROUTE 183
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-2646
Mailing Address - Country:US
Mailing Address - Phone:973-426-1440
Mailing Address - Fax:973-426-1445
Practice Address - Street 1:2121 ROUTE 22 WEST
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805
Practice Address - Country:US
Practice Address - Phone:844-437-3482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0483851Medicaid