1427481555 NPI number — SUPERIOR CARE 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 1427481555 NPI number — SUPERIOR CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPERIOR 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:
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:
1427481555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11412 N W 1PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-345-6511
Provider Business Mailing Address Fax Number:
954-345-5899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11412 NW 1ST PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33071-8107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-345-6511
Provider Business Practice Location Address Fax Number:
954-345-5899
Provider Enumeration Date:
08/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
JOY
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
954-345-6511

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL10458 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 012867600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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