1841335908 NPI number — CAPITAL HOME HEALTH, LLC

Table of content: (NPI 1841335908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841335908 NPI number — CAPITAL HOME HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL HOME HEALTH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CONCIERGE HOME CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841335908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4655 SALISBURY RD STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256-0957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-733-1003
Provider Business Mailing Address Fax Number:
904-448-8855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2075 CENTRE POINTE BLVD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-7835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-553-4002
Provider Business Practice Location Address Fax Number:
850-553-4004
Provider Enumeration Date:
02/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
G
Authorized Official Title or Position:
SECRETARY & CAO
Authorized Official Telephone Number:
904-733-1003

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  20500096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2050096 . This is a "AHCA STATE LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10D0884270 . This is a "CLIA WAIVER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".