Provider Demographics
NPI:1275334864
Name:SUPREME HOME CARE, INC.
Entity type:Organization
Organization Name:SUPREME HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNAE
Authorized Official - Last Name:GARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-294-5100
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-0661
Mailing Address - Country:US
Mailing Address - Phone:704-776-4361
Mailing Address - Fax:
Practice Address - Street 1:2661 W ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-0453
Practice Address - Country:US
Practice Address - Phone:704-776-4361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care