Provider Demographics
NPI:1033708763
Name:SUPERIOR CONCIERGE CARE,LLC
Entity Type:Organization
Organization Name:SUPERIOR CONCIERGE CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-251-9922
Mailing Address - Street 1:155 WESTRIDGE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3050
Mailing Address - Country:US
Mailing Address - Phone:678-251-9922
Mailing Address - Fax:
Practice Address - Street 1:155 WESTRIDGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3050
Practice Address - Country:US
Practice Address - Phone:678-251-9922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251J00000XAgenciesNursing Care