Healthcare Provider Details

I. General information

NPI: 1861785602
Provider Name (Legal Business Name): SUPREME HEALTH & TRANSPORT SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4572 N AVENIDA POLACCA
TUCSON AZ
85749-9524
US

IV. Provider business mailing address

PO BOX 32667
TUCSON AZ
85751-2667
US

V. Phone/Fax

Practice location:
  • Phone: 520-529-9039
  • Fax:
Mailing address:
  • Phone: 520-529-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateAZ

VIII. Authorized Official

Name: MS. DEBBIE ELAINE OKOJIE
Title or Position: OWNER
Credential:
Phone: 520-529-9039