Provider Demographics
NPI:1003082421
Name:SUPREME HOME HEALTH SERVICES INC
Entity Type:Organization
Organization Name:SUPREME HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-323-5489
Mailing Address - Street 1:1110 JACKSON ST
Mailing Address - Street 2:PO BOX 3145
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-2024
Mailing Address - Country:US
Mailing Address - Phone:318-323-5489
Mailing Address - Fax:318-323-8602
Practice Address - Street 1:1110 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-2024
Practice Address - Country:US
Practice Address - Phone:318-323-5489
Practice Address - Fax:318-323-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3586311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1462233Medicaid