Provider Demographics
NPI:1740862903
Name:SUPERIOR HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:SUPERIOR HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHADESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-286-7409
Mailing Address - Street 1:PO BOX 251661
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-1661
Mailing Address - Country:US
Mailing Address - Phone:313-395-4090
Mailing Address - Fax:
Practice Address - Street 1:6725 DALY RD UNIT 251661
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48325-3268
Practice Address - Country:US
Practice Address - Phone:313-395-4090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health