Provider Demographics
NPI:1922410497
Name:CAPITOL CITY HOME HEALTH AND REHAB
Entity Type:Organization
Organization Name:CAPITOL CITY HOME HEALTH AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:OWNER
Authorized Official - Phone:334-590-8087
Mailing Address - Street 1:8853 CHANTILLY WAY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-6672
Mailing Address - Country:US
Mailing Address - Phone:334-590-8087
Mailing Address - Fax:
Practice Address - Street 1:8202 OLD FEDERAL RD STE A
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8030
Practice Address - Country:US
Practice Address - Phone:334-590-8087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12649251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health