Provider Demographics
NPI:1962951038
Name:SUPREME QUALITY HOME CARE LLC
Entity type:Organization
Organization Name:SUPREME QUALITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-454-9388
Mailing Address - Street 1:1046 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-9085
Mailing Address - Country:US
Mailing Address - Phone:404-454-9388
Mailing Address - Fax:
Practice Address - Street 1:1046 PALMER RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-9085
Practice Address - Country:US
Practice Address - Phone:404-454-9388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044R1382251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health