Provider Demographics
NPI:1265179634
Name:SUPREME HEALTHCARE OF FLORIDA
Entity type:Organization
Organization Name:SUPREME HEALTHCARE OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-601-3480
Mailing Address - Street 1:801 W BAY DR STE 334
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3227
Mailing Address - Country:US
Mailing Address - Phone:727-601-3480
Mailing Address - Fax:
Practice Address - Street 1:801 W BAY DR STE 334
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3227
Practice Address - Country:US
Practice Address - Phone:727-601-3480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health