Healthcare Provider Details

I. General information

NPI: 1205683992
Provider Name (Legal Business Name): SUPREME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 N FALLS CIR
PINGREE GROVE IL
60140-5438
US

IV. Provider business mailing address

575 N FALLS CIR
PINGREE GROVE IL
60140-5438
US

V. Phone/Fax

Practice location:
  • Phone: 708-275-0928
  • Fax:
Mailing address:
  • Phone: 708-275-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ADENIKE OSHIN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 708-275-0928