Provider Demographics
NPI:1952604365
Name:SUPREME INVESTMENTS, LLC.
Entity Type:Organization
Organization Name:SUPREME INVESTMENTS, LLC.
Other - Org Name:SUPREME CHOICE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-1100
Mailing Address - Street 1:1100 HARDEE RD
Mailing Address - Street 2:SUITE 103 C
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-2529
Mailing Address - Country:US
Mailing Address - Phone:252-523-1100
Mailing Address - Fax:252-523-1101
Practice Address - Street 1:1100 HARDEE RD
Practice Address - Street 2:SUITE 103 C
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-2529
Practice Address - Country:US
Practice Address - Phone:252-523-1100
Practice Address - Fax:252-523-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8702079Medicaid