Provider Demographics
NPI:1942905823
Name:SUPERB CASE MGMT
Entity Type:Organization
Organization Name:SUPERB CASE MGMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LENNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:PROVIDER
Authorized Official - Phone:404-561-1435
Mailing Address - Street 1:3300 BROWNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6811
Mailing Address - Country:US
Mailing Address - Phone:404-561-1435
Mailing Address - Fax:
Practice Address - Street 1:3300 BROWNWOOD DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6811
Practice Address - Country:US
Practice Address - Phone:404-561-1435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management