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General NPI Number Information
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NPI Number | 1780797795
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Entity Type | Organization
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Legal Business Name | SUPERIOR IN-HOME CARE, INC.
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2400 W MICHIGAN AVE UNIT 21
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City | PENSACOLA
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State | FL
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Zip | 32526-2200
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Country | US
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Telephone | 850-457-1601
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Fax | 850-455-5260
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Provider Business Mailing Address
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Address Line | 2400 W MICHIGAN AVE UNIT 21
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City | PENSACOLA
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State | FL
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Zip | 32526-2200
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Country | US
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Telephone | 850-457-1601
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Fax | 850-455-5260
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MELISSA ANN ELLIS
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Credential | REGISTERED NURSE
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Telephone | 850-457-1601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 21148096
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License Number State | FL
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