Healthcare Provider Details

I. General information

NPI: 1922524560
Provider Name (Legal Business Name): SUPREME HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MOREHEAD ST STE 108
CHARLOTTE NC
28204-3025
US

IV. Provider business mailing address

1200 E MOREHEAD ST STE 108
CHARLOTTE NC
28204-3025
US

V. Phone/Fax

Practice location:
  • Phone: 704-572-7081
  • Fax: 704-733-9087
Mailing address:
  • Phone: 704-503-9771
  • Fax: 704-733-9087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. PRINCE KELECHI PAUL
Title or Position: PRESIDENT
Credential:
Phone: 704-572-7081