Provider Demographics
NPI:1003182155
Name:SUPREME LLC
Entity Type:Organization
Organization Name:SUPREME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:MASAWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-255-2574
Mailing Address - Street 1:2849 GEORGIA AVE NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-5600
Mailing Address - Country:US
Mailing Address - Phone:202-525-2175
Mailing Address - Fax:202-525-2177
Practice Address - Street 1:2849 GEORGIA AVE NW
Practice Address - Street 2:SUITE 2
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-5600
Practice Address - Country:US
Practice Address - Phone:202-525-2175
Practice Address - Fax:202-525-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health