Provider Demographics
NPI:1649420852
Name:SUPREME HOME CARE LLC
Entity Type:Organization
Organization Name:SUPREME HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:CAREY
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-340-9313
Mailing Address - Street 1:2010 WOODMERE BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058
Mailing Address - Country:US
Mailing Address - Phone:504-340-9313
Mailing Address - Fax:504-340-9314
Practice Address - Street 1:2010 WOODMERE BLVD
Practice Address - Street 2:STE B
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058
Practice Address - Country:US
Practice Address - Phone:504-340-9313
Practice Address - Fax:504-340-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASIL20096302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization