Provider Demographics
NPI:1649657073
Name:CAPITAL PROVIDER SERVICES
Entity type:Organization
Organization Name:CAPITAL PROVIDER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GISCARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-7295
Mailing Address - Street 1:16701 BEALLE HILL FOREST LN
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3351
Mailing Address - Country:US
Mailing Address - Phone:240-401-7295
Mailing Address - Fax:
Practice Address - Street 1:16701 BEALLE HILL FOREST LN
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-3351
Practice Address - Country:US
Practice Address - Phone:240-401-7295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care