MEDICARE: SUPERIOR LIVING HOMES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	174200000X	Meals Provider
2	177F00000X	Lodging Provider
3	251C00000X	Developmentally Disabled Services Day Training Agency
4	251E00000X	Home Health Agency
5	253Z00000X	In Home Supportive Care Agency
6	376G00000X	Nursing Home Administrator	MI

General Provider Information

NPI Number	:	1568973154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR LIVING HOMES, LLC

Provider Business Mailing Address
First Line	:	10699 CRABAPPLE LN
Second Line	:
City	:	RIVES JUNCTION
State	:	MI
Zip	:	49277-9746
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10699 CRABAPPLE LN
Second Line	:
City	:	RIVES JUNCTION
State	:	MI
Zip	:	49277-9746
Country	:	US
Telephone Number	:	517-489-6995
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	CAITLIN R BERLIN
Credential	:
Telephone Number	:	517-489-6995

Provider Enumeration Date	:	10/23/2017
Last Update Date	:	10/23/2017

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