Organization
SUPREME HEALTHCARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GANIYAT FUNMI EFUNTOYE (PRESIDENT/CEO)
(240) 357-8763
Entity
Organization
Contact information
Practice address
4611 CLAY ST NE, WASHINGTON, DC 20019-4663
(240) 357-8763
(240) 863-3313
Mailing address
6475 NEW HAMPSHIRE AVE, SUITE 315, HYATTSVILLE, MD 20783-3282
(240) 357-8763
(240) 863-3313
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057293200
—
DC
Enumeration date
01/18/2012
Last updated
05/11/2017
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