Healthcare Provider Details

I. General information

NPI: 1790472298
Provider Name (Legal Business Name): SUPERIORCARE CARE HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2552 POPLAR AVE STE 4F
MEMPHIS TN
38112-3834
US

IV. Provider business mailing address

2552 POPLAR AVE STE 4F
MEMPHIS TN
38112-3834
US

V. Phone/Fax

Practice location:
  • Phone: 662-408-6995
  • Fax:
Mailing address:
  • Phone: 662-408-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DONNA LUCKETT
Title or Position: DIRECTOR
Credential: NURSE PRACTITIONER
Phone: 662-408-6995