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General NPI Number Information
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NPI Number | 1922421841
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Entity Type | Organization
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Legal Business Name | SUPREME HEALTH CARE INC
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 5701 KENTUCKY AVE N SUITE 198
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City | CRYSTAL
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State | MN
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Zip | 55428-3370
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Country | US
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Telephone | 763-516-7236
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Fax | 763-533-1659
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Provider Business Mailing Address
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Address Line | 5701 KENTUCKY AVE N SUITE 198
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City | CRYSTAL
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State | MN
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Zip | 55428-3370
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Country | US
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Telephone | 763-516-7236
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Fax | 763-533-1659
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Authorized Official
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Title or Position | OWNER
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Name | ZINNAH KOLLIE CHESSON
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Credential |
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Telephone | 763-516-7236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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