Provider Demographics
NPI:1922428929
Name:CAPITAL CITY CUSTOM HOME IMPROVEMENT LLC.
Entity Type:Organization
Organization Name:CAPITAL CITY CUSTOM HOME IMPROVEMENT LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:740-474-4299
Mailing Address - Street 1:9635 US HIGHWAY 22 E
Mailing Address - Street 2:
Mailing Address - City:STOUTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43154-9607
Mailing Address - Country:US
Mailing Address - Phone:740-474-4299
Mailing Address - Fax:740-474-4297
Practice Address - Street 1:9635 US HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:STOUTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43154-9607
Practice Address - Country:US
Practice Address - Phone:740-474-4299
Practice Address - Fax:740-474-4297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No171WV0202XOther Service ProvidersContractorVehicle ModificationsGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084332Medicaid