Provider Demographics
NPI:1568644383
Name:SUPERIOR HOME CARE
Entity Type:Organization
Organization Name:SUPERIOR HOME CARE
Other - Org Name:CONTINA HAMILTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONTINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-687-5165
Mailing Address - Street 1:130 COUNTY ROAD 2700
Mailing Address - Street 2:
Mailing Address - City:SHUBUTA
Mailing Address - State:MS
Mailing Address - Zip Code:39360-8600
Mailing Address - Country:US
Mailing Address - Phone:601-687-5165
Mailing Address - Fax:601-687-5165
Practice Address - Street 1:130 COUNTY ROAD 2700
Practice Address - Street 2:
Practice Address - City:SHUBUTA
Practice Address - State:MS
Practice Address - Zip Code:39360-8600
Practice Address - Country:US
Practice Address - Phone:601-687-5165
Practice Address - Fax:601-687-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSNONE252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770604Medicaid
MS00770603Medicaid