Provider Demographics
NPI:1568631711
Name:CAPITAL RESOURCE AGENCY
Entity Type:Organization
Organization Name:CAPITAL RESOURCE AGENCY
Other - Org Name:COMFORTS OF HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-720-5413
Mailing Address - Street 1:950 KANAWHA BLVD E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2842
Mailing Address - Country:US
Mailing Address - Phone:304-720-5413
Mailing Address - Fax:304-720-5418
Practice Address - Street 1:950 KANAWHA BLVD E
Practice Address - Street 2:SUITE 1
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2842
Practice Address - Country:US
Practice Address - Phone:304-720-5413
Practice Address - Fax:304-720-5418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010882Medicaid