Provider Demographics
NPI:1164910527
Name:SUPREME HOME HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:SUPREME HOME HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-220-8781
Mailing Address - Street 1:12592 COUNTRYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-2704
Mailing Address - Country:US
Mailing Address - Phone:314-220-8781
Mailing Address - Fax:314-395-1876
Practice Address - Street 1:12592 COUNTRYBROOK DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-2704
Practice Address - Country:US
Practice Address - Phone:314-220-8781
Practice Address - Fax:314-395-1876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health