Provider Demographics
NPI:1215661186
Name:SUPER HOME CARE LLC
Entity type:Organization
Organization Name:SUPER HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIRLANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:METELLUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-249-7149
Mailing Address - Street 1:155 NW 41ST CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-2634
Mailing Address - Country:US
Mailing Address - Phone:754-249-7149
Mailing Address - Fax:
Practice Address - Street 1:155 NW 41ST CT
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-2634
Practice Address - Country:US
Practice Address - Phone:754-249-7149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health