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Organization
SUPREME HABILITATIVE SERVICES LLC
Active
Organization
SUPREME HABILITATIVE SERVICES LLC
Active
Other names
Supreme Habilitative Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RACKAYE J SIMMONS (CEO)
(866) 751-8330
Entity
Organization
Contact information
Practice address
100 S ASHLEY DR STE 600, TAMPA, FL 33602-5300
(813) 381-0595
Mailing address
100 S ASHLEY DR STE 600, TAMPA, FL 33602-5300
(866) 751-8330
(813) 922-0553
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
374U00000X
Home Health Aide
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01
—
FL
Enumeration date
06/28/2021
Last updated
11/27/2021
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