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General NPI Number Information
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NPI Number | 1922995364
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Entity Type | Organization
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Legal Business Name | SUPREME HOME HEALTHCARE
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 20 OSWEGO LN
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City | READING
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State | PA
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Zip | 19605-7018
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Country | US
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Telephone | 484-769-5070
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Fax |
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Provider Business Mailing Address
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Address Line | 20 OSWEGO LN
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City | READING
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State | PA
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Zip | 19605-7018
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Country | US
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Telephone | 484-769-5070
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Fax |
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Authorized Official
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Title or Position | GOVERNING BODY CHAIRPERSON
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Name | MR. MOHAMED FOFANAH
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Credential |
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Telephone | 614-929-1931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health 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 | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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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 | 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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