MEDICARE: CAPITOL CITY HHC

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1255183042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITOL CITY HHC

Provider Business Mailing Address
First Line	:	944 S WYOMING ST
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-2973
Country	:	US
Telephone Number	:	406-529-6539
Fax Number	:

Provider Business Practice Location Address
First Line	:	944 S WYOMING ST
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-2973
Country	:	US
Telephone Number	:	406-529-6539
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. RODNEESHA JACOBS
Credential	:
Telephone Number	:	406-529-6539

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	04/05/2024

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Directions to “CAPITOL CITY HHC ” Practice Location

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