Provider Demographics
NPI:1821395872
Name:SUPREME HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SUPREME HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KWAME
Authorized Official - Middle Name:NYARKO
Authorized Official - Last Name:AIDOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-396-6590
Mailing Address - Street 1:5900 ROCHE DR
Mailing Address - Street 2:SUITE 614
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3272
Mailing Address - Country:US
Mailing Address - Phone:614-396-6590
Mailing Address - Fax:
Practice Address - Street 1:5900 ROCHE DR
Practice Address - Street 2:SUITE 614
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3272
Practice Address - Country:US
Practice Address - Phone:614-396-6590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-26
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0076152Medicaid
OH368437Medicare PIN