Provider Demographics
NPI:1356949754
Name:SUPREME HEROS HOMECARE LLC
Entity type:Organization
Organization Name:SUPREME HEROS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCHANEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-235-6161
Mailing Address - Street 1:800 CHESTER PIKE STE 612
Mailing Address - Street 2:
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-1400
Mailing Address - Country:US
Mailing Address - Phone:610-439-9934
Mailing Address - Fax:
Practice Address - Street 1:800 CHESTER PIKE STE 612
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079-1400
Practice Address - Country:US
Practice Address - Phone:610-439-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health