MEDICARE: FIRST CAPITAL HOME HEALTH HOLDINGS, LLC

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	:	1659649457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CAPITAL HOME HEALTH HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	1878 CRAIGSHIRE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1878 CRAIGSHIRE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4006
Country	:	US
Telephone Number	:	314-205-1650
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEVIN R RUARK
Credential	:
Telephone Number	:	734-560-8953

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	12/12/2011

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