Provider Demographics
NPI:1912708744
Name:SUPREME HEALTH AND REHABILITATION SERVICES, LLC
Entity type:Organization
Organization Name:SUPREME HEALTH AND REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIJANI
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:410-940-1983
Mailing Address - Street 1:98 FOX HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3295
Mailing Address - Country:US
Mailing Address - Phone:410-940-1983
Mailing Address - Fax:
Practice Address - Street 1:98 FOX HAVEN CT
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-3295
Practice Address - Country:US
Practice Address - Phone:410-940-1983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty