1962722728 NPI number — SUPERIOR HEALTHCARE SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962722728 NPI number — SUPERIOR HEALTHCARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPERIOR HEALTHCARE SERVICES, 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:
Provider Other Organization Name Type Code:
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:
1962722728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 690547
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28227-7010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-563-6262
Provider Business Mailing Address Fax Number:
704-563-6210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 E BROAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKINGHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28379-3758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-997-3333
Provider Business Practice Location Address Fax Number:
910-895-7157
Provider Enumeration Date:
06/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
JASON
Authorized Official Middle Name:
CHRISTOPHER
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
704-361-2756

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MHL-077-062 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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