MEDICARE: SUPERB HOME CARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1578028114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERB HOME CARE INC

Provider Business Mailing Address
First Line	:	10306 217TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-1131
Country	:	US
Telephone Number	:	917-617-4758
Fax Number	:

Provider Business Practice Location Address
First Line	:	10306 217TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-1131
Country	:	US
Telephone Number	:	917-617-4758
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AUTUMN JOYCE
Credential	:	RN
Telephone Number	:	917-617-4758

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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