Provider Demographics
NPI:1366496846
Name:SUPERIOR HOME CARE, INC
Entity Type:Organization
Organization Name:SUPERIOR HOME CARE, INC
Other - Org Name:SUPERIOR HOME CARE AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-254-3200
Mailing Address - Street 1:184 E 5900 S
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7230
Mailing Address - Country:US
Mailing Address - Phone:801-254-3200
Mailing Address - Fax:801-254-8680
Practice Address - Street 1:184 E 5900 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7230
Practice Address - Country:US
Practice Address - Phone:801-254-3200
Practice Address - Fax:801-254-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-HHA-823251E00000X
UT2005-HOSPICE-55129251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========002Medicaid
UT467108Medicare Oscar/Certification
UT=========002Medicaid