Healthcare Provider Details

I. General information

NPI: 1164795530
Provider Name (Legal Business Name): SUPERIOR INNOVATIVE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BLUE CLAY RD SUITE Q BUILDING 24G
CASTLE HAYNE NC
28429
US

IV. Provider business mailing address

PO BOX 308
HAMPSTEAD NC
28443
US

V. Phone/Fax

Practice location:
  • Phone: 910-746-0396
  • Fax: 910-746-0396
Mailing address:
  • Phone: 910-319-1605
  • Fax: 910-319-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA RICHARDSON DAVIS
Title or Position: OWNER/DIRECTOR
Credential: LCSW
Phone: 910-442-9042