Healthcare Provider Details

I. General information

NPI: 1750573937
Provider Name (Legal Business Name): SUPERIOR HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MIDDLEVILLE RD
HERKIMER NY
13350
US

IV. Provider business mailing address

PO BOX 107
HERKIMER NY
13350-0107
US

V. Phone/Fax

Practice location:
  • Phone: 315-866-7932
  • Fax:
Mailing address:
  • Phone: 315-866-7932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0316L001
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. NANCY JEAN MOORE
Title or Position: OWNER
Credential:
Phone: 315-866-7932