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General NPI Number Information
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NPI Number | 1164910527
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Entity Type | Organization
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Legal Business Name | SUPREME HOME HEALTH CARE SERVICES, LLC
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 3191 ASHBY RD STE 3
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City | SAINT ANN
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State | MO
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Zip | 63074-3805
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Country | US
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Telephone | 314-395-8989
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Fax | 314-395-1876
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Provider Business Mailing Address
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Address Line | 3191 ASHBY RD STE 3
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City | SAINT ANN
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State | MO
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Zip | 63074-3805
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Country | US
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Telephone | 314-395-8989
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Fax | 314-395-1876
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LAKECIA GRAY
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Credential |
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Telephone | 314-395-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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