MEDICARE: SUPERIOR CARE HOME AGENCY, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1558248047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR CARE HOME AGENCY, LLC

Provider Business Mailing Address
First Line	:	1320 N HAMILTON ST STE 105
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27262-2731
Country	:	US
Telephone Number	:	336-807-6469
Fax Number	:	336-885-8966

Provider Business Practice Location Address
First Line	:	1320 N HAMILTON ST STE 105
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27262-2731
Country	:	US
Telephone Number	:	336-807-6469
Fax Number	:	336-885-8966

Authorized Official
Title or Position	:	AGENCY DIRECTOR/ OWNER
Name	:	LAKISHA JONES
Credential	:
Telephone Number	:	336-807-6469

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	08/20/2025

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