MEDICARE: SUPERIOR CONNECTIONS 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	251S00000X	Community/Behavioral Health Agency	NV20171693289	NV

General Provider Information

NPI Number	:	1770095903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR CONNECTIONS SERVICES LLC

Provider Business Mailing Address
First Line	:	4220 GLOBE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0746
Country	:	US
Telephone Number	:	702-427-4537
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 S RAINBOW BLVD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9080
Country	:	US
Telephone Number	:	702-427-4537
Fax Number	:

Authorized Official
Title or Position	:	CEO/CO OWNER
Name	:	MS. EBONY C GRANADOS
Credential	:	MSW
Telephone Number	:	702-427-4537

Provider Enumeration Date	:	10/27/2017
Last Update Date	:	10/27/2017

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Directions to “SUPERIOR CONNECTIONS SERVICES LLC ” Practice Location

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