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General NPI Number Information
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NPI Number | 1679347637
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Entity Type | Organization
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Legal Business Name | SUPREME LEADERSHIP LLC
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 2875 NE 191ST ST OFC 540
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City | MIAMI
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State | FL
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Zip | 33180-2801
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Country | US
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Telephone | 786-733-3576
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 VAN BUREN ST APT 14
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City | HOLLYWOOD
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State | FL
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Zip | 33020-5176
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Country | US
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Telephone | 407-350-7084
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Fax |
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Authorized Official
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Title or Position | FRANCHISE OWNER
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Name | MR. RICARDO REY LOPEZ
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Credential | MPH
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Telephone | 407-350-7084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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