Provider Demographics
NPI:1861845612
Name:SUPERIOR SENIOR CARE LLC
Entity Type:Organization
Organization Name:SUPERIOR SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:WARNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-472-3352
Mailing Address - Street 1:10856 N 2070 RD
Mailing Address - Street 2:
Mailing Address - City:CANUTE
Mailing Address - State:OK
Mailing Address - Zip Code:73626
Mailing Address - Country:US
Mailing Address - Phone:580-472-3352
Mailing Address - Fax:580-472-3497
Practice Address - Street 1:10856 N 2070 RD
Practice Address - Street 2:
Practice Address - City:CANUTE
Practice Address - State:OK
Practice Address - Zip Code:73626-3620
Practice Address - Country:US
Practice Address - Phone:580-472-3352
Practice Address - Fax:580-472-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251E00000X
OKHC8056253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKHC8056OtherOSDH