Provider Demographics
NPI:1386227692
Name:CAP CITY SUPPORTED LIVING & HOMECARE SERVICES
Entity type:Organization
Organization Name:CAP CITY SUPPORTED LIVING & HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS - AGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-266-1079
Mailing Address - Street 1:5875 CHANTRY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4764
Mailing Address - Country:US
Mailing Address - Phone:614-626-3720
Mailing Address - Fax:614-626-3728
Practice Address - Street 1:5875 CHANTRY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4764
Practice Address - Country:US
Practice Address - Phone:614-626-3720
Practice Address - Fax:614-626-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1770961054Medicaid