Provider Demographics
NPI:1164816617
Name:CAPITOL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:CAPITOL HEALTHCARE, INC.
Other - Org Name:HORIZON HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:55 W WILLOWBROOK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3242
Mailing Address - Country:US
Mailing Address - Phone:208-344-9228
Mailing Address - Fax:
Practice Address - Street 1:55 W WILLOWBROOK DR STE 101
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-3242
Practice Address - Country:US
Practice Address - Phone:208-344-9228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0001088788Medicaid