MEDICARE: SUPREME HOME HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	1010559	IL

General Provider Information

NPI Number	:	1316990815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPREME HOME HEALTH INC

Provider Business Mailing Address
First Line	:	2625 BUTTERFIELD RD
Second Line	:	SUITE 128N
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1234
Country	:	US
Telephone Number	:	630-945-9200
Fax Number	:	630-945-9204

Provider Business Practice Location Address
First Line	:	2625 BUTTERFIELD RD
Second Line	:	SUITE 128N
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1234
Country	:	US
Telephone Number	:	630-945-9200
Fax Number	:	630-945-9204

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JESUSA BUNIAO
Credential	:
Telephone Number	:	630-945-9200

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/22/2020

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