Provider Demographics
NPI:1780207977
Name:SUPER HOME CARE LLC
Entity Type:Organization
Organization Name:SUPER HOME CARE LLC
Other - Org Name:SUPER HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER -MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:OMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-829-9083
Mailing Address - Street 1:1230 S PARKER RD STE 217
Mailing Address - Street 2:1230 S PARKER RD STE 217
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2119
Mailing Address - Country:US
Mailing Address - Phone:303-728-9154
Mailing Address - Fax:303-728-9154
Practice Address - Street 1:1230 S PARKER RD STE 217
Practice Address - Street 2:1230 S PARKER RD STE 217
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2119
Practice Address - Country:US
Practice Address - Phone:303-728-9154
Practice Address - Fax:303-728-9154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO112440310OtherHOMEMAKER CES/SLS