Provider Demographics
NPI:1881806057
Name:SUPER HEALTH CARE, INC
Entity type:Organization
Organization Name:SUPER HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-991-1009
Mailing Address - Street 1:6795 E TENNESSEE AVENUE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224
Mailing Address - Country:US
Mailing Address - Phone:303-991-1009
Mailing Address - Fax:303-388-3152
Practice Address - Street 1:6795 E TENNESSEE AVENUE
Practice Address - Street 2:SUITE 225
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224
Practice Address - Country:US
Practice Address - Phone:303-991-1009
Practice Address - Fax:303-388-3152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72006757251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA72006757Medicaid
CA72006757Medicaid