Provider Demographics
NPI:1568904233
Name:SUPREME HEALTH CARE LLC
Entity Type:Organization
Organization Name:SUPREME HEALTH CARE LLC
Other - Org Name:SUPREME HEALTH CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AGYEMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANU-DAPAAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-313-8456
Mailing Address - Street 1:161 BOARDWALK GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3915
Mailing Address - Country:US
Mailing Address - Phone:314-680-9471
Mailing Address - Fax:
Practice Address - Street 1:161 BOARDWALK GARDENS DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3915
Practice Address - Country:US
Practice Address - Phone:314-314-3219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-12
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care