Provider Demographics
NPI:1497014195
Name:SUPERIOR HOME CARE
Entity Type:Organization
Organization Name:SUPERIOR HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RICH-PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-409-1835
Mailing Address - Street 1:PO BOX 91665
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-1665
Mailing Address - Country:US
Mailing Address - Phone:863-409-1835
Mailing Address - Fax:863-875-5977
Practice Address - Street 1:1597 DOVES VIEW CIR
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-2754
Practice Address - Country:US
Practice Address - Phone:863-409-1835
Practice Address - Fax:863-875-5977
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOD'S LOVINGCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA190825374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty