MEDICARE: SUPERIOR CONCIERGE CARE,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1033708763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR CONCIERGE CARE,LLC

Provider Business Mailing Address
First Line	:	155 WESTRIDGE PKWY STE 110
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-3050
Country	:	US
Telephone Number	:	678-251-9922
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 WESTRIDGE PKWY STE 110
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-3050
Country	:	US
Telephone Number	:	678-251-9922
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	THERESA PUGH
Credential	:	RN
Telephone Number	:	678-251-9922

Provider Enumeration Date	:	01/17/2021
Last Update Date	:	01/17/2021

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