Provider Demographics
NPI:1760867477
Name:SUPERIOR CARE HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:SUPERIOR CARE HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:EKUFU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:772-678-6994
Mailing Address - Street 1:1320 SE FEDERAL HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3407
Mailing Address - Country:US
Mailing Address - Phone:772-678-6994
Mailing Address - Fax:877-581-9583
Practice Address - Street 1:1320 SE FEDERAL HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3407
Practice Address - Country:US
Practice Address - Phone:772-678-6994
Practice Address - Fax:877-581-9583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994443251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016515900Medicaid
FL1760867477OtherNPI
FL299994443OtherFLORIDA LICENSE
FL68-7020Medicare PIN