Provider Demographics
NPI:1750966628
Name:SUPERIOR CARE & SUPPORT, LLC
Entity type:Organization
Organization Name:SUPERIOR CARE & SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MUSA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BANGURA
Authorized Official - Suffix:SR
Authorized Official - Credentials:RN
Authorized Official - Phone:571-247-6503
Mailing Address - Street 1:4355 RIDGEWOOD CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5308
Mailing Address - Country:US
Mailing Address - Phone:703-665-4479
Mailing Address - Fax:703-291-8287
Practice Address - Street 1:4355 RIDGEWOOD CENTER DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5308
Practice Address - Country:US
Practice Address - Phone:703-665-4479
Practice Address - Fax:703-291-8287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities