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General NPI Number Information
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NPI Number | 1497014195
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Entity Type | Organization
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Legal Business Name | SUPERIOR HOME CARE
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 1597 DOVES VIEW CIR
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City | AUBURNDALE
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State | FL
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Zip | 33823-2754
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Country | US
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Telephone | 863-409-1835
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Fax | 863-875-5977
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Provider Business Mailing Address
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Address Line | PO BOX 91665
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City | LAKELAND
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State | FL
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Zip | 33804-1665
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Country | US
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Telephone | 863-409-1835
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Fax | 863-875-5977
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Authorized Official
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Title or Position | TREASURE
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Name | MRS. ANTOINETTE MARIE RICH-PAYNE
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Credential |
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Telephone | 863-409-1835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | CNA190825
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License Number State | FL
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