Basic Information
Provider Information
NPI: 1386814093
EntityType: 2
ReplacementNPI:  
OrganizationName: CAPUANO PRIVATE HOME CARE INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 265 BENTON DR
Address2: SUITE 201
City: E LONGMEADOW
State: MA
PostalCode: 010283219
CountryCode: US
TelephoneNumber: 4135252124
FaxNumber: 4135255691
Practice Location
Address1: 265 BENTON DR
Address2: SUITE 201
City: E LONGMEADOW
State: MA
PostalCode: 010283219
CountryCode: US
TelephoneNumber: 4135252124
FaxNumber: 4135255691
Other Information
ProviderEnumerationDate: 03/10/2008
LastUpdateDate: 06/21/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LIN
AuthorizedOfficialFirstName: FANNIE
AuthorizedOfficialMiddleName: Y
AuthorizedOfficialTitleorPosition: CEO CFO
AuthorizedOfficialTelephone: 4135252124
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251E00000X  Y AgenciesHome Health 

No ID Information.


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