MEDICARE: SUPREME CARE SERVICESLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1427982396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPREME CARE SERVICESLLC

Provider Business Mailing Address
First Line	:	4738 68TH AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1400
Country	:	US
Telephone Number	:	301-814-1509
Fax Number	:

Provider Business Practice Location Address
First Line	:	4738 68TH AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1400
Country	:	US
Telephone Number	:	301-814-1509
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KORPO KOLLIE JOHNSON
Credential	:
Telephone Number	:	301-814-1509

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “SUPREME CARE SERVICESLLC ” Practice Location

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