MEDICARE: SUPREME HOME HEALTH CARE, LLC

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	299992504	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912095142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPREME HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	8910 MIRAMAR PKWY STE 315
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-4100
Country	:	US
Telephone Number	:	954-431-1681
Fax Number	:	954-431-1699

Provider Business Practice Location Address
First Line	:	8910 MIRAMAR PKWY STE 315
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-4100
Country	:	US
Telephone Number	:	954-431-1681
Fax Number	:	954-431-1699

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CANUTE V ANDERSON
Credential	:	R.N.
Telephone Number	:	954-431-1681

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	10/29/2010

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Directions to “SUPREME HOME HEALTH CARE, LLC ” Practice Location

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