Provider Demographics
NPI:1699057117
Name:SUPREME CARE, INC.
Entity type:Organization
Organization Name:SUPREME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-225-2056
Mailing Address - Street 1:3004 FORRESTAL DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-4780
Mailing Address - Country:US
Mailing Address - Phone:919-225-2056
Mailing Address - Fax:919-287-2733
Practice Address - Street 1:4307 WESTERN PARK PL
Practice Address - Street 2:SUITE 205-A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-1224
Practice Address - Country:US
Practice Address - Phone:919-225-2056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-10
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4439251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health