Provider Demographics
NPI:1497041016
Name:CAPITOL CARE SOUTH
Entity Type:Organization
Organization Name:CAPITOL CARE SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:205-956-2000
Mailing Address - Street 1:2601 COMMERCE BLVD
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-1211
Mailing Address - Country:US
Mailing Address - Phone:205-956-2000
Mailing Address - Fax:
Practice Address - Street 1:2601 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-1211
Practice Address - Country:US
Practice Address - Phone:205-956-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health