Provider Demographics
NPI:1508010265
Name:SUPREME HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUPREME HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CACHERO
Authorized Official - Last Name:MEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-802-2281
Mailing Address - Street 1:3525 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3324
Mailing Address - Country:US
Mailing Address - Phone:773-802-2281
Mailing Address - Fax:888-316-6045
Practice Address - Street 1:3525 W. PETERSON AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3324
Practice Address - Country:US
Practice Address - Phone:773-802-2281
Practice Address - Fax:888-316-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health