Provider Demographics
NPI:1841244472
Name:SUPREME HOME CARE SERVICES INC.
Entity Type:Organization
Organization Name:SUPREME HOME CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEZIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-512-8365
Mailing Address - Street 1:3312 MIDLAND CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3312 MIDLAND CT
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2504
Practice Address - Country:US
Practice Address - Phone:443-512-8365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2408P251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health