Provider Demographics
NPI:1083862999
Name:SUPREME PERSONAL HOME CARE
Entity Type:Organization
Organization Name:SUPREME PERSONAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MOPELOLA
Authorized Official - Middle Name:BUNMI
Authorized Official - Last Name:ADEBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-650-0450
Mailing Address - Street 1:7302 CHASEGROVE LANE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469
Mailing Address - Country:US
Mailing Address - Phone:281-238-0502
Mailing Address - Fax:
Practice Address - Street 1:7302 CHASEGROVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407
Practice Address - Country:US
Practice Address - Phone:281-650-0450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103236310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility