# SUPREME LOVE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1891922217
- **Authorized official:** BETTY FORSYTHE (OWNER)
- **Authorized official phone:** (252) 234-6163

## Contact information

- **Practice address:** 4232 COGHILL DR N, WILSON, NC 27896-9503
- **Practice address phone:** (252) 234-6163
- **Practice address fax:** (252) 234-6163
- **Mailing address:** 4232 COGHILL DR N, WILSON, NC 27896-9503
- **Mailing address phone:** (252) 234-6163
- **Mailing address fax:** (252) 234-6163

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL098132 | NC | Yes |

## Other

- **Enumeration date:** 06/11/2009
- **Last updated:** 06/11/2009