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General NPI Number Information
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NPI Number | 1104762996
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Entity Type | Organization
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Legal Business Name | SUPERIOR INNOVATIVE SERVICES II
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Dates
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Enumeration Date | 04/25/2026
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Last Update Date | 04/25/2026
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Provider Practice Location Address
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Address Line | 5000 BLUE CLAY RD STE D
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City | CASTLE HAYNE
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State | NC
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Zip | 28429-6302
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Country | US
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Telephone | 910-352-9720
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 308
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City | HAMPSTEAD
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State | NC
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Zip | 28443-0308
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Country | US
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Telephone | 910-352-9720
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. CHARLES DAVIS
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Credential |
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Telephone | 910-352-9720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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