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Organization

SUPREME HOME CARE, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GARY DAVIS (PRESIDENT)
(602) 454-0155
Entity
Organization

Contact information

Practice address
1204 E BASELINE RD STE 204, TEMPE, AZ 85283-1453
(602) 454-0155
(602) 454-0156
Mailing address
1204 E BASELINE RD STE 204, TEMPE, AZ 85283-1453
(602) 454-0155
(602) 454-0156

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HHA3554
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
927577
AZ
Enumeration date
04/17/2007
Last updated
09/27/2021
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