Provider Demographics
NPI:1922995364
Name:SUPREME HOME HEALTHCARE
Entity type:Organization
Organization Name:SUPREME HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVERNING BODY CHAIRPERSON
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:FOFANAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-929-1931
Mailing Address - Street 1:20 OSWEGO LN
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-7018
Mailing Address - Country:US
Mailing Address - Phone:484-769-5070
Mailing Address - Fax:
Practice Address - Street 1:20 OSWEGO LN
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-7018
Practice Address - Country:US
Practice Address - Phone:484-769-5070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children