Provider Demographics
NPI:1225135437
Name:SUPREME HOME HEALTH SERVICES INC
Entity Type:Organization
Organization Name:SUPREME HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-325-8863
Mailing Address - Street 1:1110 JACKSON ST
Mailing Address - Street 2:PO BOX 3145
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-2024
Mailing Address - Country:US
Mailing Address - Phone:318-323-5489
Mailing Address - Fax:318-323-8602
Practice Address - Street 1:1110 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-2024
Practice Address - Country:US
Practice Address - Phone:318-323-5489
Practice Address - Fax:318-323-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA121251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH83053OtherVANTAGE HEALTH PLAN, INC.
LA10525OtherINFLUENZA VACCINE
LA33530OtherBLUE CROSS BLUE SHIELD
LA140095Medicaid
LA1930033530ZOtherBLUE CROSS BLUE SHIELD KE
LAH83053OtherVANTAGE HEALTH PLAN, INC.
LA1930033530ZOtherBLUE CROSS BLUE SHIELD KE