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General NPI Number Information
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NPI Number | 1366741316
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Entity Type | Organization
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Legal Business Name | SUPREME CARE PROFESSIONAL NURSING AGENCY, P.A.
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 3535 S WILMINGTON ST SUITE 104
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City | RALEIGH
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State | NC
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Zip | 27603-3562
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Country | US
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Telephone | 919-931-9704
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 S WILMINGTON ST SUITE 104
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City | RALEIGH
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State | NC
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Zip | 27603-3562
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Country | US
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Telephone | 919-931-9704
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Fax |
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Authorized Official
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Title or Position | DIRECTO
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Name | MRS. CHRISTIANA O ABISOGUN
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Credential | RN
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Telephone | 919-931-9704
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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 | HC4335
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License Number State | NC
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