Provider Demographics
NPI:1245604453
Name:SUPERIOR HOME CARE NURSING, LLC
Entity Type:Organization
Organization Name:SUPERIOR HOME CARE NURSING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:GIST
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:952-898-5400
Mailing Address - Street 1:10603 165TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-3514
Mailing Address - Country:US
Mailing Address - Phone:952-898-5400
Mailing Address - Fax:952-898-5454
Practice Address - Street 1:10603 165TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-3514
Practice Address - Country:US
Practice Address - Phone:952-898-5400
Practice Address - Fax:952-898-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health