Provider Demographics
NPI:1679629992
Name:SUPERIOR SUPPORT LLC
Entity Type:Organization
Organization Name:SUPERIOR SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KONAL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-772-3523
Mailing Address - Street 1:30643 HIDDEN PINES LN
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-7302
Mailing Address - Country:US
Mailing Address - Phone:586-772-3523
Mailing Address - Fax:
Practice Address - Street 1:30643 HIDDEN PINES LN
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-7302
Practice Address - Country:US
Practice Address - Phone:586-772-3523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB2110Y1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P27170Medicare ID - Type Unspecified