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Organization
SUPRA HOME HEALTH, INC.
Active
Organization
SUPRA HOME HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVEL PRIETO (ADMINISTRATOR)
(954) 443-6461
Entity
Organization
Contact information
Practice address
6720 TAFT ST, HOLLYWOOD, FL 33024-3903
(954) 443-6461
(954) 443-6462
Mailing address
6720 TAFT ST, HOLLYWOOD, FL 33024-3903
(954) 443-6461
(954) 443-6462
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
299992774
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
299992774
LICENSE
FL
05
—
651652100
—
FL
Enumeration date
05/29/2007
Last updated
04/17/2020
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