MEDICARE: SUPREME HOMECARE AGENCY OF NY 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	251E00000X	Home Health Agency	1935L001	NY

General Provider Information

NPI Number	:	1962868570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPREME HOMECARE AGENCY OF NY INC

Provider Business Mailing Address
First Line	:	15405 NORTHERN BLVD FL 3
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-6724
Country	:	US
Telephone Number	:	718-888-0855
Fax Number	:	718-353-9212

Provider Business Practice Location Address
First Line	:	15405 NORTHERN BLVD FL 3
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-6724
Country	:	US
Telephone Number	:	718-888-0855
Fax Number	:	718-353-9212

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YOUNGSOON LEE
Credential	:
Telephone Number	:	718-888-0855

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	04/08/2026

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