Provider Demographics
NPI:1093089583
Name:SUPREME INVESTMENTS,LLC
Entity Type:Organization
Organization Name:SUPREME INVESTMENTS,LLC
Other - Org Name:SUPREME CHOICE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-1100
Mailing Address - Street 1:2407 GRACE AVE
Mailing Address - Street 2:SUITES 4-5
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-4416
Mailing Address - Country:US
Mailing Address - Phone:252-772-2304
Mailing Address - Fax:252-523-1101
Practice Address - Street 1:2407 GRACE AVE
Practice Address - Street 2:STE 4-5
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4416
Practice Address - Country:US
Practice Address - Phone:252-772-2304
Practice Address - Fax:252-523-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418755Medicaid