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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