Provider Demographics
NPI:1063875938
Name:SUPREME HOME HEALTH CARE
Entity type:Organization
Organization Name:SUPREME HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-807-7848
Mailing Address - Street 1:6925 MICHELLE PL
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6925 MICHELLE PL
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-3708
Practice Address - Country:US
Practice Address - Phone:513-807-7848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health