Provider Demographics
NPI:1366507089
Name:SUPERIOR HOME HEALTH CARE SERVICES INC
Entity Type:Organization
Organization Name:SUPERIOR HOME HEALTH CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:SALTIBAN
Authorized Official - Last Name:PULANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-946-0186
Mailing Address - Street 1:555 NORTH BENSON AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5075
Mailing Address - Country:US
Mailing Address - Phone:909-946-0186
Mailing Address - Fax:909-946-0118
Practice Address - Street 1:555 NORTH BENSON AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5075
Practice Address - Country:US
Practice Address - Phone:909-946-0186
Practice Address - Fax:909-946-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-8423OtherMEDICARE PROVIDER NUMBER
CA05-8423OtherMEDICARE PROVIDER NUMBER