Provider Demographics
NPI:1023188786
Name:ALLSUPREME HOME CARE INC
Entity Type:Organization
Organization Name:ALLSUPREME HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GANDIONCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-273-8616
Mailing Address - Street 1:13110 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5126
Mailing Address - Country:US
Mailing Address - Phone:310-273-8616
Mailing Address - Fax:310-273-8282
Practice Address - Street 1:13110 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5126
Practice Address - Country:US
Practice Address - Phone:310-273-8616
Practice Address - Fax:310-273-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001438251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-8191Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION #