Provider Demographics
NPI:1053071530
Name:SUPER HOME CARE LLC
Entity Type:Organization
Organization Name:SUPER HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:OMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-829-9083
Mailing Address - Street 1:1230 S PARKER RD STE 17217
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2118
Mailing Address - Country:US
Mailing Address - Phone:303-728-9154
Mailing Address - Fax:
Practice Address - Street 1:1230 S PARKER RD STE 217
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2119
Practice Address - Country:US
Practice Address - Phone:303-728-9154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals