MEDICARE: SUPERIOR SUPPORT HEALTHCARE AGENCY INC.

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	251C00000X	Developmentally Disabled Services Day Training Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1255205225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR SUPPORT HEALTHCARE AGENCY INC.

Provider Business Mailing Address
First Line	:	6050 MONCRIEF RD STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-2564
Country	:	US
Telephone Number	:	904-379-5844
Fax Number	:

Provider Business Practice Location Address
First Line	:	6050 MONCRIEF RD STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-2564
Country	:	US
Telephone Number	:	904-379-5844
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MARKIA CAMPBELL
Credential	:
Telephone Number	:	904-379-5844

Provider Enumeration Date	:	10/02/2025
Last Update Date	:	10/02/2025

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