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General NPI Number Information
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NPI Number | 1699057117
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Entity Type | Organization
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Legal Business Name | SUPREME CARE, INC.
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Dates
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Enumeration Date | 09/10/2011
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 4307 WESTERN PARK PL SUITE 205-A
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City | DURHAM
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State | NC
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Zip | 27705-1224
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Country | US
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Telephone | 919-225-2056
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Fax |
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Provider Business Mailing Address
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Address Line | 3004 FORRESTAL DR
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City | DURHAM
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State | NC
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Zip | 27703-4780
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Country | US
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Telephone | 919-225-2056
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Fax | 919-287-2733
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Authorized Official
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Title or Position | AGENCY DIRECTOR
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Name | MR. JULIUS AJAYI
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Credential |
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Telephone | 919-225-2056
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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 | HC4439
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License Number State | NC
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