Provider Demographics
NPI:1689337297
Name:SUPREME CARE HOSPICE INC
Entity Type:Organization
Organization Name:SUPREME CARE HOSPICE INC
Other - Org Name:SUPREME CARE HOSPICE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDELEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-881-8170
Mailing Address - Street 1:13201 N 35TH AVE STE B7A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1222
Mailing Address - Country:US
Mailing Address - Phone:602-881-8170
Mailing Address - Fax:
Practice Address - Street 1:13201 N 35TH AVE STE B7A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1222
Practice Address - Country:US
Practice Address - Phone:323-394-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based