Provider Demographics
NPI:1720469893
Name:SUPRENE HOME CARE GIVERS AGENCY LLC
Entity type:Organization
Organization Name:SUPRENE HOME CARE GIVERS AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMALA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-989-3576
Mailing Address - Street 1:32385 GLEN CV
Mailing Address - Street 2:5
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3663
Mailing Address - Country:US
Mailing Address - Phone:313-782-4814
Mailing Address - Fax:313-338-8985
Practice Address - Street 1:3011 W GRAND BLVD
Practice Address - Street 2:858
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3096
Practice Address - Country:US
Practice Address - Phone:313-782-4814
Practice Address - Fax:313-338-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIE29729251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health