Provider Demographics
NPI:1679838007
Name:SUPERIOR OPS, LLC
Entity Type:Organization
Organization Name:SUPERIOR OPS, LLC
Other - Org Name:LIGHTHOUSE OF SUPERIOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-721-2800
Mailing Address - Street 1:1915 N 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5575
Mailing Address - Country:US
Mailing Address - Phone:218-721-2800
Mailing Address - Fax:
Practice Address - Street 1:1915 N 34TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5575
Practice Address - Country:US
Practice Address - Phone:218-721-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility