Organization
SUPREME HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AJOKE OLOHIMA KOLAWOLE B.A., CNA (ADMINISTRATOR)
(907) 830-6959
Entity
Organization
Contact information
Practice address
2600A BRYANT CIR, ANCHORAGE, AK 99507-3252
(907) 929-1141
(907) 868-4670
Mailing address
2600 A BRYANT CIRCLE, P.O BOX 142764, ANCHORAGE, AK 99514-2764
(907) 929-1141
(907) 868-4670
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1030505
—
AK
Enumeration date
02/01/2018
Last updated
02/05/2018
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