Healthcare Provider Details

I. General information

NPI: 1477858090
Provider Name (Legal Business Name): SUPERIOR NURSING, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 13TH AVE
MENDOTA IL
61342-1486
US

IV. Provider business mailing address

1201 13TH AVE
MENDOTA IL
61342-1486
US

V. Phone/Fax

Practice location:
  • Phone: 815-538-2921
  • Fax: 815-538-4812
Mailing address:
  • Phone: 815-538-2921
  • Fax: 815-538-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4000270
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4000270
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3000536
License Number StateIL

VIII. Authorized Official

Name: JEANETTE F. SCHAMMEL
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 815-538-2921