Provider Demographics
NPI:1144641200
Name:CAPSTONE TREATMENT CENTER
Entity type:Organization
Organization Name:CAPSTONE TREATMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:P
Authorized Official - Last Name:TZYSTUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-573-4315
Mailing Address - Street 1:922B S EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6324
Mailing Address - Country:US
Mailing Address - Phone:304-573-4315
Mailing Address - Fax:
Practice Address - Street 1:922B S EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6324
Practice Address - Country:US
Practice Address - Phone:304-573-4315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGEVIEW URGENT CARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center