Provider Demographics
NPI:1508377318
Name:SUPREME HOME HEALTH CARE AGENCY LLC
Entity Type:Organization
Organization Name:SUPREME HOME HEALTH CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMOGIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELHILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-936-3582
Mailing Address - Street 1:66 LINCOLN ST FL 1
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-2311
Mailing Address - Country:US
Mailing Address - Phone:201-936-3582
Mailing Address - Fax:888-959-8179
Practice Address - Street 1:66 LINCOLN ST FL 1
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-2311
Practice Address - Country:US
Practice Address - Phone:201-936-3582
Practice Address - Fax:888-959-8179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care