Provider Demographics
NPI:1063056216
Name:SUPREME SUPPORT SYSTEM INC
Entity type:Organization
Organization Name:SUPREME SUPPORT SYSTEM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FOLASHADE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPE
Authorized Official - Suffix:
Authorized Official - Credentials:SOCIAL WORKER
Authorized Official - Phone:443-653-6186
Mailing Address - Street 1:8904 TRIMBLE WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3910
Mailing Address - Country:US
Mailing Address - Phone:443-983-6590
Mailing Address - Fax:410-558-6879
Practice Address - Street 1:8904 TRIMBLE WAY
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3910
Practice Address - Country:US
Practice Address - Phone:443-983-6590
Practice Address - Fax:410-558-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child