Provider Demographics
NPI:1932214285
Name:SUPERIOR HOME HEALTH LLC
Entity Type:Organization
Organization Name:SUPERIOR HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CYBULSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-772-5241
Mailing Address - Street 1:4054 W NORTH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-5223
Mailing Address - Country:US
Mailing Address - Phone:773-772-5241
Mailing Address - Fax:773-772-5245
Practice Address - Street 1:4054 W NORTH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-5223
Practice Address - Country:US
Practice Address - Phone:773-772-5241
Practice Address - Fax:773-772-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010230251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010230Medicaid
IL147733Medicare ID - Type UnspecifiedHOME HEALTH