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General NPI Number Information
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NPI Number | 1861762700
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Entity Type | Organization
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Legal Business Name | A SUPREME NURSING AND HOMECARE, LLC
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 3400 CHAPEL HILL RD 104
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1739
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Country | US
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Telephone | 678-224-5971
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Fax | 888-524-7084
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Provider Business Mailing Address
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Address Line | 3400 CHAPEL HILL RD 104
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1739
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Country | US
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Telephone | 678-224-5971
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Fax | 888-524-7084
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ANDREA LORRAINE BROWN-JOSEPH
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Credential |
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Telephone | 678-224-5973
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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 | 048-R-0730
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License Number State | GA
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