Provider Demographics
NPI:1356763270
Name:SUPREME NURSING AGENCY
Entity type:Organization
Organization Name:SUPREME NURSING AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HHA
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:BEMPAH
Authorized Official - Last Name:ANAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:301-768-0636
Mailing Address - Street 1:631 SHERIDAN ST APT 32
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3225
Mailing Address - Country:US
Mailing Address - Phone:301-768-0636
Mailing Address - Fax:
Practice Address - Street 1:631 SHERIDAN ST APT 32
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3225
Practice Address - Country:US
Practice Address - Phone:301-768-0636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-12
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9902251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health