Provider Demographics
NPI:1659835213
Name:SUPREME COMPASSIONATE CARE INCORPORATED
Entity Type:Organization
Organization Name:SUPREME COMPASSIONATE CARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DELPHINIA
Authorized Official - Middle Name:LOWERY
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-528-1459
Mailing Address - Street 1:1540 WESTBROOK PLAZA DR STE C
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1331
Mailing Address - Country:US
Mailing Address - Phone:336-528-1459
Mailing Address - Fax:
Practice Address - Street 1:1540 WESTBROOK PLAZA DR STE C
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1331
Practice Address - Country:US
Practice Address - Phone:336-528-1459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care