MEDICARE: DADE SUPREME SERVICE, INC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1679040315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DADE SUPREME SERVICE, INC

Provider Business Mailing Address
First Line	:	2818 NW 169TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4437
Country	:	US
Telephone Number	:	786-521-4794
Fax Number	:	786-524-3257

Provider Business Practice Location Address
First Line	:	2818 NW 169TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4437
Country	:	US
Telephone Number	:	786-521-4794
Fax Number	:	786-524-3257

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JUDITT MILIAN
Credential	:
Telephone Number	:	786-521-4794

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	10/31/2018

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