Provider Demographics
NPI:1730479890
Name:CAPTURA 22, INC.
Entity Type:Organization
Organization Name:CAPTURA 22, INC.
Other - Org Name:COMFORCARE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-718-8276
Mailing Address - Street 1:9013 NE HIGHWAY 99 STE Q
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8943
Mailing Address - Country:US
Mailing Address - Phone:360-718-8276
Mailing Address - Fax:360-885-1565
Practice Address - Street 1:9013 NE HIGHWAY 99 STE Q
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8943
Practice Address - Country:US
Practice Address - Phone:360-718-8276
Practice Address - Fax:360-885-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHSFS60203382253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care