# SUPREME HEALTH CARE SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386838571
- **Authorized official:** MR. JOHN OMONKHUALE MADOJEMU MSM, PHD (C) (PROGRAM DIRECTOR)
- **Authorized official phone:** (757) 393-0327

## Contact information

- **Practice address:** 3300 TYRE NECK ROAD, SUITE F, PORTSMOUTH, VA 23703-3319
- **Practice address phone:** (757) 393-0327
- **Practice address fax:** (757) 393-0328
- **Mailing address:** 3300 TYRE NECK ROAD, SUITE F, PORTSMOUTH, VA 23703-3319
- **Mailing address phone:** (757) 393-0327
- **Mailing address fax:** (757) 393-0328

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 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