Provider Demographics
NPI:1639548621
Name:CAPSTONE HEALTHCARE,L.L.C
Entity Type:Organization
Organization Name:CAPSTONE HEALTHCARE,L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSHANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-334-0095
Mailing Address - Street 1:1001 GREAT OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3124
Mailing Address - Country:US
Mailing Address - Phone:386-492-5635
Mailing Address - Fax:386-246-7418
Practice Address - Street 1:1001 GREAT OAKS DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-3124
Practice Address - Country:US
Practice Address - Phone:386-492-5635
Practice Address - Fax:386-246-7418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-19
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility