Provider Demographics
NPI:1457828329
Name:SUPREME MANAGEMENT AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SUPREME MANAGEMENT AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:FORRIE
Authorized Official - Last Name:FLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-291-0518
Mailing Address - Street 1:107 1/2 W CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29702-1501
Mailing Address - Country:US
Mailing Address - Phone:864-492-3400
Mailing Address - Fax:
Practice Address - Street 1:107 1/2 W CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:SC
Practice Address - Zip Code:29702-1501
Practice Address - Country:US
Practice Address - Phone:864-492-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health