Healthcare Provider Details

I. General information

NPI: 1568904233
Provider Name (Legal Business Name): SUPREME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2016
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 BOARDWALK GARDENS DR
O FALLON MO
63368-3915
US

IV. Provider business mailing address

161 BOARDWALK GARDENS DR
O FALLON MO
63368-3915
US

V. Phone/Fax

Practice location:
  • Phone: 314-314-3219
  • Fax:
Mailing address:
  • Phone: 314-680-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: MR. AGYEMAN MANU-DAPAAH
Title or Position: OWNER
Credential:
Phone: 314-313-8456