Provider Demographics
NPI:1427327675
Name:SUPREME HOSPICE INC
Entity type:Organization
Organization Name:SUPREME HOSPICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-832-1144
Mailing Address - Street 1:350 WESTPARK WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3741
Mailing Address - Country:US
Mailing Address - Phone:469-208-8495
Mailing Address - Fax:469-208-8494
Practice Address - Street 1:2410 LUNA RD STE 280
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6572
Practice Address - Country:US
Practice Address - Phone:877-832-1144
Practice Address - Fax:469-208-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014659OtherHHS HOSPICE LICENSE