Organization
SUPREME FAMILY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIUS AJAYI (ADMINISTRATOR)
(919) 225-2056
Entity
Organization
Contact information
Practice address
1120 BENNING ST, DURHAM, NC 27703-1504
(919) 973-3724
Mailing address
1120 BENNING ST, DURHAM, NC 27703-1504
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
FCL-032-137
NC
Other
Enumeration date
11/17/2014
Last updated
11/17/2014
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