Healthcare Provider Details

I. General information

NPI: 1548513492
Provider Name (Legal Business Name): SUPERIOR HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 GRAFTON AVE SUITE B
DAYTON OH
45406-5438
US

IV. Provider business mailing address

302 GRAFTON AVE SUITE B
DAYTON OH
45406-5438
US

V. Phone/Fax

Practice location:
  • Phone: 937-716-0651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS CELITA MCBETH
Title or Position: MANAGER
Credential:
Phone: 937-716-0651