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General NPI Number Information
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NPI Number | 1912708744
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Entity Type | Organization
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Legal Business Name | SUPREME HEALTH AND REHABILITATION SERVICES, LLC
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 98 FOX HAVEN CT
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City | REISTERSTOWN
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State | MD
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Zip | 21136-3295
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Country | US
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Telephone | 410-940-1983
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Fax |
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Provider Business Mailing Address
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Address Line | 98 FOX HAVEN CT
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City | REISTERSTOWN
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State | MD
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Zip | 21136-3295
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Country | US
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Telephone | 410-940-1983
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEHINDE TIJANI
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Credential | OT
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Telephone | 410-940-1983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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