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General NPI Number Information
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NPI Number | 1700336211
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Entity Type | Organization
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Legal Business Name | SUPREME HOSPICE INC
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 28312 CONSTELLATION RD SUITE B
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City | VALENCIA
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State | CA
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Zip | 91355-5078
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Country | US
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Telephone | 661-388-4328
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Fax | 661-402-2337
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Provider Business Mailing Address
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Address Line | 28312 CONSTELLATION RD SUITE B
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City | VALENCIA
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State | CA
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Zip | 91355-5078
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Country | US
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Telephone | 661-388-4328
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Fax | 661-402-2337
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MS. CAROLYN P ROMERO
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Credential | BSN, RN
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Telephone | 818-268-8813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State | CA
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