Provider Demographics
NPI:1578341574
Name:SUPREME HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUPREME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-290-5419
Mailing Address - Street 1:747 QUEEN CITY PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-4366
Mailing Address - Country:US
Mailing Address - Phone:678-769-3233
Mailing Address - Fax:470-290-5419
Practice Address - Street 1:747 QUEEN CITY PKWY STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-4366
Practice Address - Country:US
Practice Address - Phone:678-769-3233
Practice Address - Fax:470-290-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health