Provider Demographics
NPI:1437464542
Name:SUPERIOR HOME HEALTHCARE
Entity Type:Organization
Organization Name:SUPERIOR HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-866-7932
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-0107
Mailing Address - Country:US
Mailing Address - Phone:315-866-7932
Mailing Address - Fax:315-866-1914
Practice Address - Street 1:703 MIDDLEVILLE RD
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-0107
Practice Address - Country:US
Practice Address - Phone:315-866-7932
Practice Address - Fax:315-866-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2167551302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY301768-1OtherLICENSED PRACTICAL NURSE