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Organization

SUPREME CARE WELLNESS GROUP LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JACOLBY TILLMAN (OWNER)
(561) 449-3147
Entity
Organization

Contact information

Practice address
1736 NW CATALUNA CIR, PORT SAINT LUCIE, FL 34986-5800
(561) 449-3147
Mailing address
1736 NW CATALUNA CIR, PORT SAINT LUCIE, FL 34986-5800
(561) 449-3147

Taxonomy

Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary

Other

Enumeration date
02/22/2023
Last updated
02/22/2023
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