# SUPREME AMBULANCE INC

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

## Provider details

- **NPI number:** 1649500489
- **Authorized official:** MR. RICK LARSON (VPO)
- **Authorized official phone:** (855) 775-8585

## Contact information

- **Practice address:** 5300 SAN FERNANDO RD, GLENDALE, CA 91203-2407
- **Practice address phone:** (855) 775-8585
- **Practice address fax:** (855) 775-8787
- **Mailing address:** 5300 SAN FERNANDO RD, GLENDALE, CA 91203-2407
- **Mailing address phone:** (855) 775-8585
- **Mailing address fax:** (855) 775-8787

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | — | — | Yes |

## Other

- **Enumeration date:** 12/29/2009
- **Last updated:** 07/24/2012