Healthcare Provider Details

I. General information

NPI: 1215670047
Provider Name (Legal Business Name): SUPREME HEALTHCARE & WELLNESS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 MIDDLEBROOK RD STE 190
GERMANTOWN MD
20874-1521
US

IV. Provider business mailing address

12401 MIDDLEBROOK RD STE 190
GERMANTOWN MD
20874-1521
US

V. Phone/Fax

Practice location:
  • Phone: 240-476-2106
  • Fax: 877-775-1766
Mailing address:
  • Phone: 855-208-0890
  • Fax: 240-317-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUDITH AKOH-ARREY
Title or Position: PROVIDER
Credential: NP
Phone: 240-432-6971