Provider Demographics
NPI:1558981845
Name:SUPER HOME CARE LLC
Entity Type:Organization
Organization Name:SUPER HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWMER -MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:OMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-829-9083
Mailing Address - Street 1:1230 S PARKER RD STE 217
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2119
Mailing Address - Country:US
Mailing Address - Phone:720-829-9083
Mailing Address - Fax:
Practice Address - Street 1:715 QUINCE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6188
Practice Address - Country:US
Practice Address - Phone:720-829-9083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care