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Contact Information

SUPREME HEALTHCARE SERVICES, LLC
4611 CLAY ST NE
WASHINGTON, DC20019-4663
 Phone: 240-357-8763
 Fax: 240-863-3313
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Custodial Care Facility

311Z00000X
Indicates primary specialty

NPI Profile & details for SUPREME HEALTHCARE SERVICES, LLC

NPI # 1871864124
LBN Legal business name SUPREME HEALTHCARE SERVICES, LLC
Authorized official GANIYAT EFUNTOYE - (PRESIDENT/CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 01/18/2012
Last updated 05/11/2017 - About 9 years ago
Identifiers
DC Medicaid 057293200
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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