# SUPREME NURSING CARE AND SUPPORTED LIVING LLC

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

## Provider details

- **NPI number:** 1982175154
- **Authorized official:** MR. MOHAMED BABA FOFANAH MPH (CEO)
- **Authorized official phone:** (614) 929-1931

## Contact information

- **Practice address:** 1401 MARLTON PIKE E STE 22A, CHERRY HILL, NJ 08034-2207
- **Practice address phone:** (614) 929-1931
- **Mailing address:** 1101 W HAMILTON ST STE 141, ALLENTOWN, PA 18101-1043
- **Mailing address phone:** (614) 929-1931

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | — | NULL | — |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |

## Other

- **Enumeration date:** 12/16/2018
- **Last updated:** 02/05/2025