Healthcare Provider Details

I. General information

NPI: 1437537651
Provider Name (Legal Business Name): SUPERIOR HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2985 WAUGHTOWN ST
WINSTON SALEM NC
27107-1620
US

IV. Provider business mailing address

267 OLDE VINYARD CT
WINSTON SALEM NC
27104-9998
US

V. Phone/Fax

Practice location:
  • Phone: 336-775-6005
  • Fax:
Mailing address:
  • Phone: 336-775-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHC4651
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC4651
License Number StateNC

VIII. Authorized Official

Name: MISS SHEKEBA GAITHER
Title or Position: OWNER
Credential:
Phone: 336-775-6005