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General NPI Number Information
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NPI Number | 1902560279
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Entity Type | Organization
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Legal Business Name | SUPREME HEALTHCARE SERVICES LLC.
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Dates
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Enumeration Date | 10/23/2021
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Last Update Date | 10/23/2021
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Provider Practice Location Address
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Address Line | 694 MERRIMACK ST UNIT A
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City | LOWELL
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State | MA
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Zip | 01854-3915
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Country | US
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Telephone | 978-970-5545
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Fax | 978-970-0006
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Provider Business Mailing Address
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Address Line | 694 MERRIMACK ST UNIT A
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City | LOWELL
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State | MA
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Zip | 01854-3915
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Country | US
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Telephone | 978-970-5545
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Fax | 978-970-0006
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL TEMBO
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Credential |
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Telephone | 978-970-5545
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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