Healthcare Provider Details

I. General information

NPI: 1841335908
Provider Name (Legal Business Name): CAPITAL HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 E 19TH ST STE B
PANAMA CITY FL
32405-4718
US

IV. Provider business mailing address

4655 SALISBURY RD STE 110
JACKSONVILLE FL
32256-0957
US

V. Phone/Fax

Practice location:
  • Phone: 850-553-4002
  • Fax: 850-553-4004
Mailing address:
  • Phone: 904-733-1003
  • Fax: 904-448-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number20500096
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT G YOUNG
Title or Position: SECRETARY & CAO
Credential:
Phone: 904-733-1003