Provider Demographics
NPI:1033666805
Name:SUPREME HOME HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:SUPREME HOME HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMBO
Authorized Official - Suffix:
Authorized Official - Credentials:BSC BUSINESS/NURSE
Authorized Official - Phone:510-205-5422
Mailing Address - Street 1:694 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3915
Mailing Address - Country:US
Mailing Address - Phone:510-205-5422
Mailing Address - Fax:978-667-9742
Practice Address - Street 1:694 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3915
Practice Address - Country:US
Practice Address - Phone:510-205-5422
Practice Address - Fax:978-667-9742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health