Healthcare Provider Details

I. General information

NPI: 1346383742
Provider Name (Legal Business Name): CAPITAL HEALTH SUPPLY COMPANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 PHILADELPHIA DR FLOOR 1
DAYTON OH
45415-3653
US

IV. Provider business mailing address

5020 PHILADELPHIA DR FLOOR 1
DAYTON OH
45415-3653
US

V. Phone/Fax

Practice location:
  • Phone: 937-277-9410
  • Fax: 937-277-9410
Mailing address:
  • Phone: 937-277-9410
  • Fax: 937-277-9410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA HUFF
Title or Position: VICE PRESIDENT
Credential:
Phone: 937-277-9410