Provider Demographics
NPI:1770649220
Name:SUPERIOR NURSING AND SITTING SERVS
Entity Type:Organization
Organization Name:SUPERIOR NURSING AND SITTING SERVS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-566-0483
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:MS
Mailing Address - Zip Code:39154-0660
Mailing Address - Country:US
Mailing Address - Phone:601-566-0483
Mailing Address - Fax:601-857-8328
Practice Address - Street 1:937 W LAKE DOCKERY DR
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9003
Practice Address - Country:US
Practice Address - Phone:601-566-0483
Practice Address - Fax:601-665-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01504520Medicaid