Provider Demographics
NPI:1811750144
Name:SUPER HOME CARE LLC
Entity type:Organization
Organization Name:SUPER HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ENEST
Authorized Official - Middle Name:
Authorized Official - Last Name:NYAMUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-307-7604
Mailing Address - Street 1:5678 PLANET DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5046
Mailing Address - Country:US
Mailing Address - Phone:513-307-7604
Mailing Address - Fax:
Practice Address - Street 1:5678 PLANET DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5046
Practice Address - Country:US
Practice Address - Phone:513-307-7604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care