Provider Demographics
NPI:1558475293
Name:SUPERIOR CARE HOME, INC
Entity type:Organization
Organization Name:SUPERIOR CARE HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-442-6884
Mailing Address - Street 1:100 MARSHALL COURT
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4075
Mailing Address - Country:US
Mailing Address - Phone:270-442-6884
Mailing Address - Fax:
Practice Address - Street 1:100 MARSHALL COURT
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4075
Practice Address - Country:US
Practice Address - Phone:270-442-6884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100312314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054705OtherANTHEM
KY0934160001Medicare NSC
KY0934160001Medicare NSC
KY12500559Medicaid