Healthcare Provider Details

I. General information

NPI: 1104519982
Provider Name (Legal Business Name): SUPREME HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W POINSETT ST
GREER SC
29650-1455
US

IV. Provider business mailing address

5 RYAN ST
TAYLORS SC
29687-4842
US

V. Phone/Fax

Practice location:
  • Phone: 347-278-9784
  • Fax:
Mailing address:
  • Phone: 347-278-9784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: YAHNICK MARTIN
Title or Position: OWNER
Credential:
Phone: 347-278-9784