Provider Demographics
NPI:1578776696
Name:SUPERIOR HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:SUPERIOR HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-361-2756
Mailing Address - Street 1:P.O BOX 690546
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227
Mailing Address - Country:US
Mailing Address - Phone:704-563-6262
Mailing Address - Fax:704-563-6210
Practice Address - Street 1:6636 E WT HARRIS BLVD
Practice Address - Street 2:SUITE D - E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-5133
Practice Address - Country:US
Practice Address - Phone:704-563-6262
Practice Address - Fax:704-563-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301682HMedicaid
NC8301682BMedicaid
NC8301682GMedicaid