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General NPI Number Information
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NPI Number | 1144735044
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Entity Type | Organization
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Legal Business Name | SUPERIOR CARE LLC
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 3646 CAYMUS DR
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City | SPARKS
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State | NV
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Zip | 89436-7133
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Country | US
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Telephone | 775-287-5508
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Fax |
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Provider Business Mailing Address
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Address Line | 3646 CAYMUS DR
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City | SPARKS
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State | NV
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Zip | 89436-7133
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Country | US
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Telephone | 775-287-5508
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAPHAEL NUTAKOR
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Credential |
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Telephone | 775-287-5508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | NV
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