Provider Demographics
NPI:1821742693
Name:CAPRIO, TERESA LIZBETH (HCBS PROVIDER)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LIZBETH
Last Name:CAPRIO
Suffix:
Gender:F
Credentials:HCBS PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SW 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-1720
Mailing Address - Country:US
Mailing Address - Phone:954-436-1900
Mailing Address - Fax:954-440-3156
Practice Address - Street 1:13711 SW 52ND PL
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33330-2523
Practice Address - Country:US
Practice Address - Phone:954-434-3184
Practice Address - Fax:954-440-3156
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10-3044GH320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692249096Medicaid