Provider Demographics
NPI:1912097122
Name:SUPERB HOME CARE INC
Entity Type:Organization
Organization Name:SUPERB HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:SR
Authorized Official - Credentials:ATTORNEY
Authorized Official - Phone:919-680-8600
Mailing Address - Street 1:PO BOX 884
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702
Mailing Address - Country:US
Mailing Address - Phone:919-680-8600
Mailing Address - Fax:919-680-8601
Practice Address - Street 1:305 A TILGHMAN DRIVE
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334
Practice Address - Country:US
Practice Address - Phone:910-892-5051
Practice Address - Fax:910-892-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2460251E00000X
NCHC2560251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
6601117OtherPCS
6601027OtherPCS
3409649OtherCAP