Provider Demographics
NPI:1205022738
Name:SUPERB HOME HEALTH AGENCY INC.
Entity Type:Organization
Organization Name:SUPERB HOME HEALTH AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-212-0916
Mailing Address - Street 1:370 CRENSHAW BLVD
Mailing Address - Street 2:SUITE E202L
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1727
Mailing Address - Country:US
Mailing Address - Phone:310-212-0916
Mailing Address - Fax:310-212-1443
Practice Address - Street 1:370 CRENSHAW BLVD
Practice Address - Street 2:SUITE E202L
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1727
Practice Address - Country:US
Practice Address - Phone:310-212-0916
Practice Address - Fax:310-212-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57505FMedicaid
CAHHA57505FMedicaid