Provider Demographics
NPI:1740416155
Name:SUPERIOR SUPPORTED CARE SERVICES LLC
Entity Type:Organization
Organization Name:SUPERIOR SUPPORTED CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-263-8823
Mailing Address - Street 1:1375 1ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARCADIA
Mailing Address - State:LA
Mailing Address - Zip Code:71001-3511
Mailing Address - Country:US
Mailing Address - Phone:318-263-8823
Mailing Address - Fax:318-263-2461
Practice Address - Street 1:1375 1ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-3511
Practice Address - Country:US
Practice Address - Phone:318-263-8823
Practice Address - Fax:318-263-2461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASIL 20147253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care