Provider Demographics
NPI:1174781645
Name:SUPERIOR SENIOR CARE
Entity type:Organization
Organization Name:SUPERIOR SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRAWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-321-1743
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902-0505
Mailing Address - Country:US
Mailing Address - Phone:501-321-1743
Mailing Address - Fax:501-623-7853
Practice Address - Street 1:835 CENTRAL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-5318
Practice Address - Country:US
Practice Address - Phone:501-321-1743
Practice Address - Fax:501-623-7853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR141026765251B00000X
AR141025732253Z00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123989757Medicaid
AR164215797Medicaid
AR126107752Medicaid
AR164300796Medicaid
AR164592798Medicaid
AR126106750Medicaid
AR141025732Medicaid
AR141026765Medicaid