Healthcare Provider Details

I. General information

NPI: 1720317084
Provider Name (Legal Business Name): SUPERIOR SUPPORT SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 SOUTH HIGHWAY 1651
WHITLEY CITY KY
42653-6087
US

IV. Provider business mailing address

169 SOUTH HIGHWAY 1651
WHITLEY CITY KY
42653-6087
US

V. Phone/Fax

Practice location:
  • Phone: 606-376-4151
  • Fax: 606-376-4151
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS A HUNTSMAN
Title or Position: EXECUTIVE DIRECTOR
Credential: SOCIAL WORKER
Phone: 606-376-4151