Provider Demographics
NPI:1073187977
Name:SUPRA HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:SUPRA HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-240-3903
Mailing Address - Street 1:14540 RAMONA BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3386
Mailing Address - Country:US
Mailing Address - Phone:323-240-3903
Mailing Address - Fax:
Practice Address - Street 1:14540 RAMONA BLVD STE 213
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3386
Practice Address - Country:US
Practice Address - Phone:323-240-3903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health