=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912097122
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPERB HOME CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 A TILGHMAN DRIVE
-----------------------------------------------------
City | DUNN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-892-5051
-----------------------------------------------------
Fax | 910-892-8845
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 884
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-680-8600
-----------------------------------------------------
Fax | 919-680-8601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. WADE WAYNE PERRY SR.
-----------------------------------------------------
Credential | ATTORNEY
-----------------------------------------------------
Telephone | 919-680-8600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC2560
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC2460
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------