# SUPREME FAMILY CARE HOME

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

## Provider details

- **NPI number:** 1639575723
- **Authorized official:** JULIUS AJAYI (ADMINISTRATOR)
- **Authorized official phone:** (919) 225-2056

## Contact information

- **Practice address:** 1120 BENNING ST, DURHAM, NC 27703-1504
- **Practice address phone:** (919) 973-3724
- **Mailing address:** 1120 BENNING ST, DURHAM, NC 27703-1504

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | FCL-032-137 | NC | Yes |

## Other

- **Enumeration date:** 11/17/2014
- **Last updated:** 11/17/2014