MEDICARE: CAP CITY SUPPORTED LIVING & HOME CARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1770961054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAP CITY SUPPORTED LIVING & HOME CARE SERVICES

Provider Business Mailing Address
First Line	:	3445 LIVINGSTON AVENUE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227
Country	:	US
Telephone Number	:	614-867-5310
Fax Number	:	614-867-5834

Provider Business Practice Location Address
First Line	:	3445 E LIVINGSTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2220
Country	:	US
Telephone Number	:	614-867-5310
Fax Number	:	614-867-5834

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLCIA THOMAS
Credential	:
Telephone Number	:	614-867-5310

Provider Enumeration Date	:	05/07/2015
Last Update Date	:	05/07/2015

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