Provider Demographics
NPI:1972768448
Name:SUPERIOR SERVICES FOR ELDERLY DISABLED LLC
Entity type:Organization
Organization Name:SUPERIOR SERVICES FOR ELDERLY DISABLED LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-298-2273
Mailing Address - Street 1:2575 COUNTY ROAD 220
Mailing Address - Street 2:STE 107
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-6550
Mailing Address - Country:US
Mailing Address - Phone:904-298-2273
Mailing Address - Fax:904-298-2279
Practice Address - Street 1:2575 COUNTY ROAD 220
Practice Address - Street 2:STE 107
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-6550
Practice Address - Country:US
Practice Address - Phone:904-298-2273
Practice Address - Fax:904-298-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230670251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health