- Enrollment id
- O20201224000028
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1871193169
- Multiple npi flag
- N
- Ccn
- 757154
- Associate id
- 5294147856
- Organization name
- SUPREME HOME CARE SERVICES INC
- Incorporation date
- 2020-08-13
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 100 N BRAND BLVD
- Address line 2
- STE 416
- City
- GLENDALE
- State
- CA
- Zip code
- 912032614