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Organization
SUPREME HOME LLC
Active
Organization
SUPREME HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AJOKE OLOHIMA WALKER KOLAWOLE BA, C.N.A (ADMINISTRATOR)
(907) 830-6959
Entity
Organization
Contact information
Practice address
1735 MINERVA WAY, ANCHORAGE, AK 99515-1490
(907) 334-6468
(907) 868-4670
Mailing address
1735 MINERVA WAY, ANCHORAGE, AK 99515-1490
(907) 334-6468
(907) 868-4670
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
311Z00000X
Custodial Care Facility
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1030505
—
AK
Enumeration date
01/26/2018
Last updated
01/26/2018
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