Provider Demographics
NPI:1639941172
Name:CAPUTO, CHERISH
Entity Type:Individual
Prefix:
First Name:CHERISH
Middle Name:
Last Name:CAPUTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36816 N 15TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-9162
Mailing Address - Country:US
Mailing Address - Phone:916-201-6305
Mailing Address - Fax:
Practice Address - Street 1:36816 N 15TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-9162
Practice Address - Country:US
Practice Address - Phone:916-201-6305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities