Provider Demographics
NPI:1689039612
Name:CAPTAIN COMMUNITY HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:CAPTAIN COMMUNITY HUMAN SERVICES, INC.
Other - Org Name:CHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GILPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-371-1185
Mailing Address - Street 1:543 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-5711
Mailing Address - Country:US
Mailing Address - Phone:518-399-4624
Mailing Address - Fax:518-399-8663
Practice Address - Street 1:543 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-5711
Practice Address - Country:US
Practice Address - Phone:518-399-4624
Practice Address - Fax:518-399-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04724021Medicaid