MEDICARE: SUPERIOR CARE HOME CARE

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1942823570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR CARE HOME CARE

Provider Business Mailing Address
First Line	:	3703 ALAFAYA HEIGHTS RD UNIT 229
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3703 ALAFAYA HEIGHTS RD UNIT 229
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7536
Country	:	US
Telephone Number	:	317-966-2648
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	TANISHA JOHNSON
Credential	:
Telephone Number	:	317-966-2648

Provider Enumeration Date	:	05/18/2020
Last Update Date	:	05/18/2020

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Directions to “SUPERIOR CARE HOME CARE ” Practice Location

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