Provider Demographics
NPI:1831383538
Name:SUPREME COMPANIONS, IN-HOME CARE & SUPPORT SERVICES,LLC
Entity type:Organization
Organization Name:SUPREME COMPANIONS, IN-HOME CARE & SUPPORT SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANEHRU
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAMADU
Authorized Official - Suffix:SR
Authorized Official - Credentials:MBA ACCTG
Authorized Official - Phone:410-415-6181
Mailing Address - Street 1:201 MILFORD MILL RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5902
Mailing Address - Country:US
Mailing Address - Phone:410-415-6181
Mailing Address - Fax:
Practice Address - Street 1:201 MILFORD MILL RD STE 101A
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5902
Practice Address - Country:US
Practice Address - Phone:410-415-6181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2526314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility