Provider Demographics
NPI:1528134897
Name:SUPERIOR FAMILY HEALTH SERVICES, CORP.
Entity type:Organization
Organization Name:SUPERIOR FAMILY HEALTH SERVICES, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNITA
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:SCULLY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:219-879-7895
Mailing Address - Street 1:111 SKWIAT LEGION AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-4550
Mailing Address - Country:US
Mailing Address - Phone:219-879-7895
Mailing Address - Fax:219-879-7603
Practice Address - Street 1:111 SKWIAT LEGION AVE STE B
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4550
Practice Address - Country:US
Practice Address - Phone:219-879-7895
Practice Address - Fax:219-879-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health