Provider Demographics
NPI:1265211171
Name:SUPERIOR HOSPICE INC.
Entity type:Organization
Organization Name:SUPERIOR HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LECY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-233-7565
Mailing Address - Street 1:800 BOONE AVE N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4468
Mailing Address - Country:US
Mailing Address - Phone:763-267-6648
Mailing Address - Fax:763-417-9999
Practice Address - Street 1:800 BOONE AVE N STE 194
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4476
Practice Address - Country:US
Practice Address - Phone:763-277-8777
Practice Address - Fax:763-277-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based