Provider Demographics
NPI:1376816033
Name:SUPER NURSES, INC.
Entity Type:Organization
Organization Name:SUPER NURSES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-927-0309
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:LUTHERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30251-0206
Mailing Address - Country:US
Mailing Address - Phone:770-927-0309
Mailing Address - Fax:770-927-3119
Practice Address - Street 1:241 CHARLIE FULLER RD STE B
Practice Address - Street 2:
Practice Address - City:GRANTVILLE
Practice Address - State:GA
Practice Address - Zip Code:30220
Practice Address - Country:US
Practice Address - Phone:770-927-0309
Practice Address - Fax:770-927-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA099-R-0571253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care