=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316990815
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPREME HOME HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2625 BUTTERFIELD RD SUITE 128N
-----------------------------------------------------
City | OAK BROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60523-1234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-945-9200
-----------------------------------------------------
Fax | 630-945-9204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2625 BUTTERFIELD RD SUITE 128N
-----------------------------------------------------
City | OAK BROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60523-1234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-945-9200
-----------------------------------------------------
Fax | 630-945-9204
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JESUSA BUNIAO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-945-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1010559
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------