Healthcare Provider Details

I. General information

NPI: 1568181063
Provider Name (Legal Business Name): SUPREME HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N WESTERN AVE STE 204
LOS ANGELES CA
90029-1087
US

IV. Provider business mailing address

1110 N WESTERN AVE STE 204
LOS ANGELES CA
90029-1087
US

V. Phone/Fax

Practice location:
  • Phone: 323-641-7177
  • Fax: 323-840-3252
Mailing address:
  • Phone: 323-641-7177
  • Fax: 323-840-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AVETIS KEBABJYAN
Title or Position: CEO
Credential:
Phone: 323-641-7177