Healthcare Provider Details

I. General information

NPI: 1366496846
Provider Name (Legal Business Name): SUPERIOR HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 E 5900 S
MURRAY UT
84107-7230
US

IV. Provider business mailing address

184 E 5900 S
MURRAY UT
84107-7230
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-3200
  • Fax: 801-254-8680
Mailing address:
  • Phone: 801-254-3200
  • Fax: 801-254-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2005-HHA-823
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number2005-HOSPICE-55129
License Number StateUT

VIII. Authorized Official

Name: MS. ANDREA L MARTINEZ
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 801-254-3200