Organization
SUPREME SUPPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNEISHIA AIRREA ANDERSON (EXECUTIVE DIRECTOR)
(832) 260-1886
Entity
Organization
Contact information
Practice address
12509 CORONA LN, HOUSTON, TX 77072-3249
(832) 260-1886
Mailing address
12509 CORONA LN, HOUSTON, TX 77072-3249
(832) 260-1886
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
05/15/2025
Last updated
05/15/2025
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