Provider Demographics
NPI:1821532599
Name:SUPREME ALL CARE HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:SUPREME ALL CARE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIRTONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-453-3839
Mailing Address - Street 1:7127 YELLOW PINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-1846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 N SAM HOUSTON PKWY E
Practice Address - Street 2:110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4038
Practice Address - Country:US
Practice Address - Phone:281-416-4664
Practice Address - Fax:281-416-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center