1154725208 NPI number — SUPER CARE INC

Table of content: (NPI 1154725208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154725208 NPI number — SUPER CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPER CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUPERCARE HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154725208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8345 FIRESTONE BLVD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
DOWNEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90241-3871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-206-4880
Provider Business Mailing Address Fax Number:
626-723-8275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 RUBERTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91201-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-206-4880
Provider Business Practice Location Address Fax Number:
626-723-8275
Provider Enumeration Date:
10/17/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CASSAR
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
800-206-4880

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  48060 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)