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General NPI Number Information
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NPI Number | 1831383538
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Entity Type | Organization
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Legal Business Name | SUPREME COMPANIONS, IN-HOME CARE & SUPPORT SERVICES,LLC
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 201 MILFORD MILL RD STE 101A
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City | PIKESVILLE
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State | MD
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Zip | 21208-5902
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Country | US
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Telephone | 410-415-6181
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Fax |
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Provider Business Mailing Address
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Address Line | 201 MILFORD MILL RD STE 101A
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City | PIKESVILLE
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State | MD
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Zip | 21208-5902
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Country | US
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Telephone | 410-415-6181
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANEHRU B HAMADU SR.
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Credential | MBA . ACCTG
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Telephone | 410-415-6181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | R2526
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License Number State | MD
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