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General NPI Number Information
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NPI Number | 1992571939
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Entity Type | Organization
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Legal Business Name | SUPREME HOME CARE GIVERS AGENCY LLC
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Dates
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Enumeration Date | 11/30/2023
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 3011 W GRAND BLVD STE 858
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City | DETROIT
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State | MI
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Zip | 48202-3077
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Country | US
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Telephone | 313-989-3576
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Fax | 313-338-3985
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Provider Business Mailing Address
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Address Line | 6601 CHELSEA BRG
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3074
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Country | US
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Telephone | 313-989-3576
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAMALA REED
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Credential |
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Telephone | 313-989-3576
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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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