Provider Demographics
NPI:1518228758
Name:CAPITOL CARE, INC.
Entity Type:Organization
Organization Name:CAPITOL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-804-0325
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 1:185 STATE ROUTE 183
Practice Address - Street 2:
Practice Address - City:STANHOPE
Practice Address - State:NJ
Practice Address - Zip Code:07874-2646
Practice Address - Country:US
Practice Address - Phone:973-426-1440
Practice Address - Fax:973-426-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0100854Medicaid