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General NPI Number Information
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NPI Number | 1033708763
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Entity Type | Organization
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Legal Business Name | SUPERIOR CONCIERGE CARE,LLC
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Dates
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Enumeration Date | 01/17/2021
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Last Update Date | 01/17/2021
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Provider Practice Location Address
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Address Line | 155 WESTRIDGE PKWY STE 110
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City | MCDONOUGH
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State | GA
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Zip | 30253-3050
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Country | US
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Telephone | 678-251-9922
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Fax |
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Provider Business Mailing Address
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Address Line | 155 WESTRIDGE PKWY STE 110
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City | MCDONOUGH
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State | GA
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Zip | 30253-3050
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Country | US
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Telephone | 678-251-9922
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | THERESA PUGH
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Credential | RN
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Telephone | 678-251-9922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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