Organization
SUPREME CARE WELLNESS GROUP LLC
Active
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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