Provider Demographics
NPI:1679040315
Name:DADE SUPREME SERVICE, INC
Entity Type:Organization
Organization Name:DADE SUPREME SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDITT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-521-4794
Mailing Address - Street 1:2818 NW 169TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4437
Mailing Address - Country:US
Mailing Address - Phone:786-521-4794
Mailing Address - Fax:786-524-3257
Practice Address - Street 1:2818 NW 169TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4437
Practice Address - Country:US
Practice Address - Phone:786-521-4794
Practice Address - Fax:786-524-3257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care