Provider Demographics
NPI:1972866713
Name:SUPERIOR INDEPEDENT CASE MANAGEMENT
Entity Type:Organization
Organization Name:SUPERIOR INDEPEDENT CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRGRAM DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-676-0186
Mailing Address - Street 1:286 BOGLE ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2898
Mailing Address - Country:US
Mailing Address - Phone:606-676-0186
Mailing Address - Fax:606-676-0670
Practice Address - Street 1:286 BOGLE ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2898
Practice Address - Country:US
Practice Address - Phone:606-676-0186
Practice Address - Fax:606-676-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0807848251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management