Provider Demographics
NPI:1386667277
Name:CAPITAL HOSPICE
Entity Type:Organization
Organization Name:CAPITAL HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PRACTICE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OTOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-531-6209
Mailing Address - Street 1:3180 FAIRVIEW PARK DR STE 600
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-4516
Mailing Address - Country:US
Mailing Address - Phone:703-351-2807
Mailing Address - Fax:703-532-1054
Practice Address - Street 1:1801 MCCORMICK DR STE 180
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5345
Practice Address - Country:US
Practice Address - Phone:301-883-0866
Practice Address - Fax:301-883-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH1541251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD100419OtherKAISER PERMANENTE
MD400402702Medicaid
MD400402702Medicaid