Provider Demographics
NPI:1821348079
Name:SUPERIOR HOME CARE L.L.C.
Entity Type:Organization
Organization Name:SUPERIOR HOME CARE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTINIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-514-9274
Mailing Address - Street 1:1210 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-1269
Mailing Address - Country:US
Mailing Address - Phone:414-514-9274
Mailing Address - Fax:
Practice Address - Street 1:1210 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1269
Practice Address - Country:US
Practice Address - Phone:414-514-9274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care