Provider Demographics
NPI:1356771752
Name:SUPER PLUS HOSPICE INC
Entity type:Organization
Organization Name:SUPER PLUS HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BAIJU
Authorized Official - Middle Name:G
Authorized Official - Last Name:PILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-528-1832
Mailing Address - Street 1:915 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3408
Mailing Address - Country:US
Mailing Address - Phone:817-528-1832
Mailing Address - Fax:
Practice Address - Street 1:915 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3408
Practice Address - Country:US
Practice Address - Phone:817-528-1832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based