MEDICARE: SUPERIOR HEALTHCARE MANAGEMENT, 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	313M00000X	Nursing Facility/Intermediate Care Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538509369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR HEALTHCARE MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	1833 10TH AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-3023
Country	:	US
Telephone Number	:	510-698-3535
Fax Number	:	510-536-4319

Provider Business Practice Location Address
First Line	:	525 E 18TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-2413
Country	:	US
Telephone Number	:	510-268-8491
Fax Number	:

Authorized Official
Title or Position	:	CEO ADMINISTRATOR
Name	:	SHIRLEY S MA
Credential	:
Telephone Number	:	510-698-3535

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	06/25/2013

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