Provider Demographics
NPI:1699961672
Name:SUPREME ANGELS HOME CARE
Entity type:Organization
Organization Name:SUPREME ANGELS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOUSSAINT
Authorized Official - Middle Name:S J
Authorized Official - Last Name:PHILOGENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-753-6652
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-0586
Mailing Address - Country:US
Mailing Address - Phone:781-753-6652
Mailing Address - Fax:781-753-0101
Practice Address - Street 1:76 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-2181
Practice Address - Country:US
Practice Address - Phone:781-753-6652
Practice Address - Fax:781-753-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MATA10D3E1456138376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty