Provider Demographics
NPI:1528352424
Name:CAPITAL CITY
Entity type:Organization
Organization Name:CAPITAL CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:DICHRISTOFERO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:401-724-8400
Mailing Address - Street 1:25 DANFORTH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3610
Mailing Address - Country:US
Mailing Address - Phone:401-455-3890
Mailing Address - Fax:401-861-0656
Practice Address - Street 1:25 DANFORTH ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3610
Practice Address - Country:US
Practice Address - Phone:401-455-3890
Practice Address - Fax:401-861-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI=========OtherTAX ID