Healthcare Provider Details

I. General information

NPI: 1568973154
Provider Name (Legal Business Name): SUPERIOR LIVING HOMES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10699 CRABAPPLE LN
RIVES JUNCTION MI
49277-9746
US

IV. Provider business mailing address

10699 CRABAPPLE LN
RIVES JUNCTION MI
49277-9746
US

V. Phone/Fax

Practice location:
  • Phone: 517-489-6995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateMI

VIII. Authorized Official

Name: CAITLIN R BERLIN
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 517-489-6995