Healthcare Provider Details

I. General information

NPI: 1922995364
Provider Name (Legal Business Name): SUPREME HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 OSWEGO LN
READING PA
19605-7018
US

IV. Provider business mailing address

20 OSWEGO LN
READING PA
19605-7018
US

V. Phone/Fax

Practice location:
  • Phone: 484-769-5070
  • Fax:
Mailing address:
  • Phone: 484-769-5070
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MOHAMED FOFANAH
Title or Position: GOVERNING BODY CHAIRPERSON
Credential:
Phone: 614-929-1931