Provider Demographics
NPI:1992832281
Name:SUPREME CARE LLC.
Entity Type:Organization
Organization Name:SUPREME CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-737-7901
Mailing Address - Street 1:7809 AIRLINE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-6440
Mailing Address - Country:US
Mailing Address - Phone:504-737-7901
Mailing Address - Fax:504-737-7903
Practice Address - Street 1:7809 AIRLINE DR STE 206
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-6440
Practice Address - Country:US
Practice Address - Phone:504-737-7901
Practice Address - Fax:504-737-7903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6681251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1582441Medicaid