Provider Demographics
NPI:1811222813
Name:CCS - CAP SERVICES
Entity Type:Organization
Organization Name:CCS - CAP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-770-1862
Mailing Address - Street 1:1409 EAST BLVD
Mailing Address - Street 2:SUITE 102-A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5817
Mailing Address - Country:US
Mailing Address - Phone:704-770-1862
Mailing Address - Fax:704-496-2113
Practice Address - Street 1:1409 EAST BLVD
Practice Address - Street 2:SUITE 102-A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5817
Practice Address - Country:US
Practice Address - Phone:704-770-1862
Practice Address - Fax:704-496-2113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA CARE SOLUTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3835251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418678Medicaid