Provider Demographics
NPI:1336128610
Name:SUPERIOR CARE PLUS, LLC
Entity type:Organization
Organization Name:SUPERIOR CARE PLUS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-883-6532
Mailing Address - Street 1:986 TIBBETTS WICK RD
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1138
Mailing Address - Country:US
Mailing Address - Phone:330-306-9651
Mailing Address - Fax:330-539-9513
Practice Address - Street 1:986 TIBBETTS WICK RD
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1138
Practice Address - Country:US
Practice Address - Phone:330-306-9651
Practice Address - Fax:330-539-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH368079251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2532709Medicaid
OH2532709Medicaid