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General NPI Number Information
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NPI Number | 1558743278
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Entity Type | Organization
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Legal Business Name | SUPERIOR ELDER CARE, LLC
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 06/19/2015
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Provider Practice Location Address
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Address Line | 39 OHIO RD
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City | LAKE WORTH
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State | FL
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Zip | 33467-3825
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Country | US
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Telephone | 954-258-3370
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Fax | 866-369-2145
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Provider Business Mailing Address
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Address Line | 39 OHIO RD
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City | LAKE WORTH
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State | FL
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Zip | 33467-3825
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY OLIPHANT
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Credential | MPH
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Telephone | 954-258-3370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12681
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License Number State | FL
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