Provider Demographics
NPI:1467862987
Name:SUPERIOR HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:SUPERIOR HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEKEBA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAITHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-775-6005
Mailing Address - Street 1:2985 WAUGHTOWN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-1620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2985 WAUGHTOWN ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1620
Practice Address - Country:US
Practice Address - Phone:404-547-4669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC140082251B00000X, 251S00000X
NCHC4651251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health