=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053683409
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPERIOR HOME CARE AND STAFFING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2012
-----------------------------------------------------
Last Update Date | 02/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13973 FARMINGTON RD
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48154-5403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-261-3576
-----------------------------------------------------
Fax | 734-338-8004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13973 FARMINGTON RD
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48154-5403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-261-3576
-----------------------------------------------------
Fax | 734-338-8004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JASON DUNLAP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-595-3123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------