Provider Demographics
NPI:1902256621
Name:CAPACITY BUILDERS INC
Entity Type:Organization
Organization Name:CAPACITY BUILDERS INC
Other - Org Name:LOU GO'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OFTEDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-326-4245
Mailing Address - Street 1:418 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401
Mailing Address - Country:US
Mailing Address - Phone:505-324-6568
Mailing Address - Fax:
Practice Address - Street 1:418 W BROADWAY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-324-6568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM56885343900000X, 344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi