Provider Demographics
NPI:1285135905
Name:SUPREME HOMECARE INC
Entity type:Organization
Organization Name:SUPREME HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLODKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-709-1191
Mailing Address - Street 1:1150 FIRST AVE STE 511
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1334
Mailing Address - Country:US
Mailing Address - Phone:646-709-1191
Mailing Address - Fax:
Practice Address - Street 1:130 ALMSHOUSE RD STE 404B
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1130
Practice Address - Country:US
Practice Address - Phone:646-709-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care