MEDICARE: SUPERIOR HOME HEALTH GROUP, CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	299993059	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING PROVIDER#	OTHER	FL	PENDING MEDICARE PROV #

General Provider Information

NPI Number	:	1285805267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR HOME HEALTH GROUP, CORP.

Provider Business Mailing Address
First Line	:	5979 NW 151ST ST STE 206
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2446
Country	:	US
Telephone Number	:	305-362-5464
Fax Number	:	305-362-5465

Provider Business Practice Location Address
First Line	:	5979 NW 151ST ST STE 206
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2446
Country	:	US
Telephone Number	:	305-362-5464
Fax Number	:	305-362-5465

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ENRIQUE M RODRIGUEZ
Credential	:
Telephone Number	:	305-362-5464

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	04/23/2010

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