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Organization
SUPREME CARE
Active
Organization
SUPREME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOHAMED BABA FOFANAH ASP, OHST (OWNER/DIRECTOR)
(614) 929-1931
Entity
Organization
Contact information
Practice address
4920 NIAGARA RD STE 406, COLLEGE PARK, MD 20740-1166
(614) 929-1931
Mailing address
449 WILLOW ST APT J, ALLENTOWN, PA 18102-5765
(614) 929-1931
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
03/26/2018
Last updated
03/26/2018
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