Provider Demographics
NPI:1275008443
Name:SUPREME CARE GROUP
Entity Type:Organization
Organization Name:SUPREME CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OGANES
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMSONYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-357-8558
Mailing Address - Street 1:15455 SAN FERNANDO MISSION BLVD STE 103B
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1342
Mailing Address - Country:US
Mailing Address - Phone:818-357-8558
Mailing Address - Fax:818-301-2384
Practice Address - Street 1:15455 SAN FERNANDO MISSION BLVD STE 103B
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1342
Practice Address - Country:US
Practice Address - Phone:818-967-9255
Practice Address - Fax:818-301-2384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health