Provider Demographics
NPI:1275978751
Name:SUPERIOR CARE PRIMARY HOME CARE PROVIDER, LLC
Entity Type:Organization
Organization Name:SUPERIOR CARE PRIMARY HOME CARE PROVIDER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:BRISELDA
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-635-4434
Mailing Address - Street 1:2402 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-4044
Mailing Address - Country:US
Mailing Address - Phone:956-724-5299
Mailing Address - Fax:956-724-5296
Practice Address - Street 1:2402 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-4044
Practice Address - Country:US
Practice Address - Phone:956-724-5299
Practice Address - Fax:956-724-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care