MEDICARE: SUPREME HOME HEALTH SERVICES, 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	311Z00000X	Custodial Care Facility	3586	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1660094	OTHER	LA	PERSONAL CARE ATTENDANT

General Provider Information

NPI Number	:	1669566675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPREME HOME HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 3145
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71210-3145
Country	:	US
Telephone Number	:	318-323-5489
Fax Number	:	318-323-8602

Provider Business Practice Location Address
First Line	:	1110 JACKSON ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-2024
Country	:	US
Telephone Number	:	318-323-5489
Fax Number	:	318-323-8602

Authorized Official
Title or Position	:	C.E.O.
Name	:	MRS. EMILY B. WINSTON
Credential	:	R.N.
Telephone Number	:	318-323-5489

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/07/2008

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Directions to “SUPREME HOME HEALTH SERVICES, INC ” Practice Location

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