Organization
SUPREME NURSING CARE AND SUPPORTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOHAMED BABA FOFANAH MPH (CEO)
(614) 929-1931
Entity
Organization
Contact information
Practice address
1401 MARLTON PIKE E STE 22A, CHERRY HILL, NJ 08034-2207
(614) 929-1931
Mailing address
1101 W HAMILTON ST STE 141, ALLENTOWN, PA 18101-1043
(614) 929-1931
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1035115810001
—
PA
Enumeration date
12/16/2018
Last updated
02/05/2025
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