MEDICARE: SUPER HOME 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	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1053071530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPER HOME CARE LLC

Provider Business Mailing Address
First Line	:	1230 S PARKER RD STE 17217
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2118
Country	:	US
Telephone Number	:	303-728-9154
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 S PARKER RD STE 217
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2119
Country	:	US
Telephone Number	:	303-728-9154
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	MR. MOHAMED ELIAS OMER
Credential	:
Telephone Number	:	720-829-9083

Provider Enumeration Date	:	12/23/2021
Last Update Date	:	12/23/2021

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Directions to “SUPER HOME CARE LLC ” Practice Location

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