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Contact Information

SUPREME HOME LLC
2600A BRYANT CIR
ANCHORAGE, AK99507-3252
 Phone: 907-929-1141
 Fax: 907-868-4670
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Custodial Care Facility

311Z00000X
Indicates primary specialty

NPI Profile & details for SUPREME HOME LLC

NPI # 1891294153
LBN Legal business name SUPREME HOME LLC
Authorized official AJOKE KOLAWOLE - (ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 02/01/2018
Last updated 02/05/2018 - About 8 years ago
Identifiers
AK Medicaid 1030505
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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