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General NPI Number Information
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NPI Number | 1295951473
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Entity Type | Organization
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Legal Business Name | SUPREME HOME CARE, INC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 1204 E BASELINE RD STE 204
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City | TEMPE
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State | AZ
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Zip | 85283-1453
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Country | US
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Telephone | 602-454-0155
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Fax | 602-454-0156
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Provider Business Mailing Address
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Address Line | 1204 E BASELINE RD STE 204
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City | TEMPE
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State | AZ
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Zip | 85283-1453
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Country | US
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Telephone | 602-454-0155
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Fax | 602-454-0156
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GARY DAVIS
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Credential |
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Telephone | 602-454-0155
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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 | HHA3554
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License Number State | AZ
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