Provider Demographics
NPI:1316276975
Name:SUPREME INVESTMENTS LLC DBA SUPREME CHOICE HEALTHCARE
Entity type:Organization
Organization Name:SUPREME INVESTMENTS LLC DBA SUPREME CHOICE HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NIKISHA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-268-3503
Mailing Address - Street 1:PO BOX 2911
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28502-2911
Mailing Address - Country:US
Mailing Address - Phone:252-268-3503
Mailing Address - Fax:
Practice Address - Street 1:1100 HARDEE RD STE 115
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-2500
Practice Address - Country:US
Practice Address - Phone:252-523-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
NCHC4168251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6602084Medicaid