Provider Demographics
NPI:1518173384
Name:SUPREME HEALTHCARE, INC
Entity Type:Organization
Organization Name:SUPREME HEALTHCARE, INC
Other - Org Name:BRIDGES HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-268-8813
Mailing Address - Street 1:28312 CONSTELLATION RD STE A
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5078
Mailing Address - Country:US
Mailing Address - Phone:818-830-1155
Mailing Address - Fax:818-334-4149
Practice Address - Street 1:28312 CONSTELLATION RD STE A
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5078
Practice Address - Country:US
Practice Address - Phone:818-830-1155
Practice Address - Fax:818-334-4149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000872251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059190Medicare Oscar/Certification