Organization
SUPREME WELLCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FIDELIS AIGBADON (OWNER)
(678) 886-9604
Entity
Organization
Contact information
Practice address
161 GATES MILL DR, LAWRENCEVILLE, GA 30045-7190
(678) 886-9604
Mailing address
161 GATES MILL DR, LAWRENCEVILLE, GA 30045-7190
(678) 886-9604
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
10/31/2025
Last updated
10/31/2025
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