Provider Demographics
NPI:1700019155
Name:SUPREME HOME HEALTH CARE INC.
Entity Type:Organization
Organization Name:SUPREME HOME HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INDIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SITARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-655-3965
Mailing Address - Street 1:492C DELAIR RD
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-7226
Mailing Address - Country:US
Mailing Address - Phone:609-655-3965
Mailing Address - Fax:609-655-3256
Practice Address - Street 1:492C DELAIR RD
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-7226
Practice Address - Country:US
Practice Address - Phone:609-655-3965
Practice Address - Fax:609-655-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0131100251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHP0131100OtherNEW JERSEY OFFICE OF THE ATTORNEY GENERAL, DIVISION OF CONSUMER AFFAIRS