Provider Demographics
NPI:1922524560
Name:SUPREME HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:SUPREME HEALTH SYSTEMS INC
Other - Org Name:MOBILITY CONCERNS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:KELECHI
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-572-7081
Mailing Address - Street 1:1200 E MOREHEAD ST STE 108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3025
Mailing Address - Country:US
Mailing Address - Phone:704-503-9771
Mailing Address - Fax:704-733-9087
Practice Address - Street 1:1200 E MOREHEAD ST STE 108
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3025
Practice Address - Country:US
Practice Address - Phone:704-572-7081
Practice Address - Fax:704-733-9087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)