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General NPI Number Information
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NPI Number | 1184391906
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Entity Type | Organization
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Legal Business Name | SUPREME HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 08/28/2021
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 1405 EXCEL DR
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City | KILLEEN
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State | TX
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Zip | 76542-6313
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Country | US
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Telephone | 254-345-1953
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Fax |
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Provider Business Mailing Address
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Address Line | 1405 EXCEL DR
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City | KILLEEN
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State | TX
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Zip | 76542-6313
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Country | US
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Telephone | 347-234-0807
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MICHAEL KENNETH WINFREE
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Credential |
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Telephone | 347-234-0807
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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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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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