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General NPI Number Information
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NPI Number | 1346388816
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Entity Type | Organization
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Legal Business Name | SUPREME VISITING NURSES, INC.
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Dates
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Enumeration Date | 02/04/2007
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 15310 S AVALON BLVD
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City | COMPTON
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State | CA
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Zip | 90220-2519
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Country | US
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Telephone | 310-808-9020
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Fax | 310-808-9021
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Provider Business Mailing Address
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Address Line | 15310 S AVALON BLVD
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City | COMPTON
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State | CA
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Zip | 90220-2519
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Country | US
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Telephone | 310-808-9020
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Fax | 310-808-9021
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. OLUFUNKE CELINAH JAIYEOLA
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Credential | REGISTERED NURSE
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Telephone | 310-808-9020
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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 | 550000683
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License Number State | CA
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