Provider Demographics
NPI:1518679133
Name:SUPERIOR SEASON IN-HOME, LLC
Entity Type:Organization
Organization Name:SUPERIOR SEASON IN-HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-215-9411
Mailing Address - Street 1:205 E US HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75693-2103
Mailing Address - Country:US
Mailing Address - Phone:430-625-7183
Mailing Address - Fax:430-625-7177
Practice Address - Street 1:205 E US HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:TX
Practice Address - Zip Code:75693-2103
Practice Address - Country:US
Practice Address - Phone:430-625-7183
Practice Address - Fax:430-625-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty