Provider Demographics
NPI:1427068980
Name:SUPERIOR MANAGED CARE, INC.
Entity type:Organization
Organization Name:SUPERIOR MANAGED CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRAOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:915-591-0900
Mailing Address - Street 1:11625 PELLICANO DR STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6242
Mailing Address - Country:US
Mailing Address - Phone:915-591-0900
Mailing Address - Fax:915-591-1430
Practice Address - Street 1:11625 PELLICANO DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6242
Practice Address - Country:US
Practice Address - Phone:915-591-0900
Practice Address - Fax:915-591-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005771251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005771OtherSTATE LICENSE
TX005771OtherSTATE LICENSE