Provider Demographics
NPI:1801907993
Name:SUPERIOR HEALTHCARE SERVICES
Entity type:Organization
Organization Name:SUPERIOR HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-361-2756
Mailing Address - Street 1:PO BOX 690547
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7010
Mailing Address - Country:US
Mailing Address - Phone:704-563-6262
Mailing Address - Fax:704-563-6210
Practice Address - Street 1:913 E. CASSWELL ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-4934
Practice Address - Country:US
Practice Address - Phone:704-694-9135
Practice Address - Fax:704-694-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300692BMedicaid
NC8300692KMedicaid
NC8300692HMedicaid
NC8300692GMedicaid
NC8300692RMedicaid