Provider Demographics
NPI:1821416256
Name:SUPERIOR BROCAGE HOLDINGS LLC
Entity Type:Organization
Organization Name:SUPERIOR BROCAGE HOLDINGS LLC
Other - Org Name:SUPEERIOR BROCAGE HOME CONTRACTOR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERQUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-328-9051
Mailing Address - Street 1:7843 BAJA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-7735
Mailing Address - Country:US
Mailing Address - Phone:225-328-9051
Mailing Address - Fax:
Practice Address - Street 1:7843 BAJA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-7735
Practice Address - Country:US
Practice Address - Phone:225-328-9051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental ModificationGroup - Multi-Specialty