Provider Demographics
NPI:1790472298
Name:SUPERIORCARE CARE HOMES
Entity Type:Organization
Organization Name:SUPERIORCARE CARE HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:662-408-6995
Mailing Address - Street 1:2552 POPLAR AVE STE 4F
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-3834
Mailing Address - Country:US
Mailing Address - Phone:662-408-6995
Mailing Address - Fax:
Practice Address - Street 1:2552 POPLAR AVE STE 4F
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-3834
Practice Address - Country:US
Practice Address - Phone:662-408-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care