Provider Demographics
NPI:1922535137
Name:SUPERIOR LIVING 'LLC'
Entity Type:Organization
Organization Name:SUPERIOR LIVING 'LLC'
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:SHANTEL
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:772-940-6771
Mailing Address - Street 1:874 SW DUNCAN TERR.
Mailing Address - Street 2:
Mailing Address - City:PSL
Mailing Address - State:FL
Mailing Address - Zip Code:34953
Mailing Address - Country:US
Mailing Address - Phone:772-940-6771
Mailing Address - Fax:
Practice Address - Street 1:496 SOUTHEAST VERADA
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:772-940-6771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9395717OtherRN