Healthcare Provider Details

I. General information

NPI: 1447582085
Provider Name (Legal Business Name): SUPREME HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 UNION AVE SUITE 207A
RUTHERFORD NJ
07070-1274
US

IV. Provider business mailing address

71 UNION AVENUE SUITE 207A
RUTHERFORD NJ
07070
US

V. Phone/Fax

Practice location:
  • Phone: 201-372-9600
  • Fax: 201-372-9550
Mailing address:
  • Phone: 201-372-9600
  • Fax: 201-372-9550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0123200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHP0123200
License Number StateNJ

VIII. Authorized Official

Name: MS. SHERYL HEFFERNAN
Title or Position: DIRECTOR OF NURSING
Credential: REGISTERED NURSE
Phone: 201-372-9600