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General NPI Number Information
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NPI Number | 1568181063
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Entity Type | Organization
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Legal Business Name | SUPREME HOME HEALTH CARE INC
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Dates
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Enumeration Date | 08/26/2022
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 1110 N WESTERN AVE STE 204
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City | LOS ANGELES
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State | CA
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Zip | 90029-1087
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Country | US
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Telephone | 323-641-7177
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Fax | 323-840-3252
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Provider Business Mailing Address
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Address Line | 1110 N WESTERN AVE STE 204
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City | LOS ANGELES
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State | CA
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Zip | 90029-1087
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Country | US
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Telephone | 323-641-7177
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Fax | 323-840-3252
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Authorized Official
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Title or Position | CEO
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Name | AVETIS KEBABJYAN
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Credential |
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Telephone | 323-641-7177
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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 |
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License Number State |
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