Provider Demographics
NPI:1699037085
Name:CAPITOL DIVERSIFIED SERVICES, LLC
Entity type:Organization
Organization Name:CAPITOL DIVERSIFIED SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-767-0055
Mailing Address - Street 1:PO BOX 92944
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-2944
Mailing Address - Country:US
Mailing Address - Phone:512-767-0055
Mailing Address - Fax:512-597-8824
Practice Address - Street 1:7724 EL DORADO DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-3005
Practice Address - Country:US
Practice Address - Phone:512-767-0055
Practice Address - Fax:512-597-8824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care