MEDICARE: SUPER CARE, LLC

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	332BX2000X	Oxygen Equipment & Supplies (DME)	MP01363	NV

General Provider Information

NPI Number	:	1679932198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPER CARE, LLC

Provider Business Mailing Address
First Line	:	16017 VALLEY BLVD.
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91744-5424
Country	:	US
Telephone Number	:	800-206-4880
Fax Number	:	626-723-8275

Provider Business Practice Location Address
First Line	:	6380 S VALLEY VIEW BLVD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3908
Country	:	US
Telephone Number	:	800-206-4880
Fax Number	:	626-723-8275

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN L CASSAR
Credential	:
Telephone Number	:	800-206-4880

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	03/20/2026

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