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Organization
CAPITOL CITY RESIDENTIAL HEALTH CARE LLC
Active
Organization
CAPITOL CITY RESIDENTIAL HEALTH CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLEE R. DERICO (ADMINISTRATOR)
(317) 632-1851
Entity
Organization
Contact information
Practice address
1608 E 10TH ST, INDIANAPOLIS, IN 46201-1902
(317) 632-1851
(866) 480-7748
Mailing address
1608 E 10TH ST, INDIANAPOLIS, IN 46201-1902
(317) 632-1851
(866) 480-7748
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
IN
Other
Enumeration date
05/22/2007
Last updated
08/22/2020
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