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Organization
SUPREME HEALTH CARE SERVICES
Active
Organization
SUPREME HEALTH CARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN OMONKHUALE MADOJEMU MSM, PHD (C) (PROGRAM DIRECTOR)
(757) 393-0327
Entity
Organization
Contact information
Practice address
3300 TYRE NECK ROAD, SUITE F, PORTSMOUTH, VA 23703-3319
(757) 393-0327
(757) 393-0328
Mailing address
3300 TYRE NECK ROAD, SUITE F, PORTSMOUTH, VA 23703-3319
(757) 393-0327
(757) 393-0328
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
251E00000X
Home Health Agency
Primary
—
NULL
251F00000X
Home Infusion Agency
—
NULL
251G00000X
Community Based Hospice Care Agency
—
NULL
251J00000X
Nursing Care Agency
—
NULL
310400000X
Assisted Living Facility
—
NULL
3104A0625X
Assisted Living Facility (Mental Illness)
—
NULL
311Z00000X
Custodial Care Facility
—
NULL
311ZA0620X
Adult Care Home Facility
—
NULL
314000000X
Skilled Nursing Facility
—
NULL
3140N1450X
Pediatric Skilled Nursing Facility
—
NULL
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
NULL
385HR2055X
Child Mental Illness Respite Care
—
NULL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
NULL
385HR2065X
Child Physical Disabilities Respite Care
—
NULL
Other
Enumeration date
08/30/2007
Last updated
08/03/2012
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