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General NPI Number Information
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NPI Number | 1275076580
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Entity Type | Organization
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Legal Business Name | SUPREME HOME CARE AGENCY OF NY INC
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Dates
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Enumeration Date | 11/18/2016
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 15405 NORTHERN BLVD FL 3
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City | FLUSHING
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State | NY
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Zip | 11354-6724
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Country | US
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Telephone | 718-888-0855
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Fax | 718-353-9212
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Provider Business Mailing Address
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Address Line | 15405 NORTHERN BLVD FL 3
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City | FLUSHING
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State | NY
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Zip | 11354-6724
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Country | US
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Telephone | 718-888-0855
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Fax | 718-353-9212
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Authorized Official
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Title or Position | CEO
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Name | YOUNGSOON LEE
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Credential |
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Telephone | 718-888-0855
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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 | 1935L001
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License Number State | NY
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