Provider Demographics
NPI:1487982260
Name:SUPREME INVESTMENTS,LLC
Entity type:Organization
Organization Name:SUPREME INVESTMENTS,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NIKISHA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-268-1519
Mailing Address - Street 1:1923 UNITED DR UNIT E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3214
Mailing Address - Country:US
Mailing Address - Phone:252-268-1519
Mailing Address - Fax:
Practice Address - Street 1:1923 UNITED DR UNIT E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3214
Practice Address - Country:US
Practice Address - Phone:252-268-1519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health