=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235674961
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APOYO SUPREMO CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2017
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 433 W. SOMERSET STREET
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-687-1894
-----------------------------------------------------
Fax | 267-270-5974
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 433 W. SOMERSET STREET
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-687-1894
-----------------------------------------------------
Fax | 267-270-5974
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SEAN A RIVERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-687-1894
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 32183601
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------