Provider Demographics
NPI:1215670047
Name:SUPREME HEALTHCARE & WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:SUPREME HEALTHCARE & WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:AKOH-ARREY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-432-6971
Mailing Address - Street 1:12401 MIDDLEBROOK RD STE 190
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1521
Mailing Address - Country:US
Mailing Address - Phone:855-208-0890
Mailing Address - Fax:240-317-4559
Practice Address - Street 1:12401 MIDDLEBROOK RD STE 190
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1521
Practice Address - Country:US
Practice Address - Phone:240-476-2106
Practice Address - Fax:877-775-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty