Healthcare Provider Details

I. General information

NPI: 1669566675
Provider Name (Legal Business Name): SUPREME HOME HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 JACKSON ST
MONROE LA
71202-2024
US

IV. Provider business mailing address

PO BOX 3145
MONROE LA
71210-3145
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-5489
  • Fax: 318-323-8602
Mailing address:
  • Phone: 318-323-5489
  • Fax: 318-323-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number3586
License Number StateLA

VIII. Authorized Official

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