Provider Demographics
NPI:1164282661
Name:SUPERIOR NEW LIFE SERVICES INC
Entity Type:Organization
Organization Name:SUPERIOR NEW LIFE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MYLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-442-8480
Mailing Address - Street 1:8009 N CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2592
Mailing Address - Country:US
Mailing Address - Phone:813-442-8480
Mailing Address - Fax:813-434-2483
Practice Address - Street 1:8009 N CAMERON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2592
Practice Address - Country:US
Practice Address - Phone:813-442-8480
Practice Address - Fax:813-434-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities