Healthcare Provider Details

I. General information

NPI: 1609644210
Provider Name (Legal Business Name): SUPREME HOME CARE GIVERS AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 W GRAND BLVD STE 858
DETROIT MI
48202-3077
US

IV. Provider business mailing address

6601 CHELSEA BRG
WEST BLOOMFIELD MI
48322-3074
US

V. Phone/Fax

Practice location:
  • Phone: 313-989-3576
  • Fax: 313-338-3985
Mailing address:
  • Phone: 313-989-3576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMALA REED
Title or Position: OWNER
Credential:
Phone: 313-989-3576