MEDICARE: SUPERIOR HEALTHCARE SERVICES, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1457977746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	1053 CROWN LANDING PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-8717
Country	:	US
Telephone Number	:	678-249-4796
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 WESTRIDGE PKWY STE 111
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 NANETTE PUGH
Credential	:	RN
Telephone Number	:	678-249-4796

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	03/23/2022

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