National Provider Identifier Database

SUPREME HOME LLC
Custodial Care Facility

A facility providing care that serves to assist an individual in the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, and using the toilet, preparation of special diets, and supervision of medication that usually can be self-administered. Custodial care essentially is personal care that does not require the continuing attention of trained medical or paramedical personnel.


Contact Information

SUPREME HOME LLC
1735 MINERVA WAY
ANCHORAGE, AK99515-1490
Phone: 907-334-6468
Fax: 907-868-4670
Website:
Specialty Taxonomy Code
* Custodial Care Facility 311Z00000X
Assisted Living Facility 310400000X
Assisted Living, Behavioral Disturbances 3104A0630X

* Indicates primary specialty

NPI Profile & details for SUPREME HOME LLC

NPI Number 1033617881
Legal business name
LBN
SUPREME HOME LLC
Authorized official AJOKE WALKER KOLAWOLE - (ADMINISTRATOR)
Entity Organization
Organization subpart No
Enumeration date 01/26/2018
Last updated 01/26/2018 - About 8 years ago
Sole proprietor1 Not specified
Identifiers
  • AK Medicaid: 1030505

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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