Provider Demographics
NPI:1609644210
Name:SUPREME HOME CARE GIVERS AGENCY LLC
Entity Type:Organization
Organization Name:SUPREME HOME CARE GIVERS AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMALA
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-989-3576
Mailing Address - Street 1:6601 CHELSEA BRG
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3074
Mailing Address - Country:US
Mailing Address - Phone:313-989-3576
Mailing Address - Fax:
Practice Address - Street 1:3011 W GRAND BLVD STE 858
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3077
Practice Address - Country:US
Practice Address - Phone:313-989-3576
Practice Address - Fax:313-338-3985
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPRENE HOME CARE GIVERS AGENCY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care