SUPREME HOME LLC NPI 1033617881

NPI Information

  • NPI: 1033617881
  • Provider Name: SUPREME HOME LLC
  • Classification: Custodial Care Facility - 311Z00000X
  • Entity Type: Organization
  • Address: 1735 MINERVA WAY
    ANCHORAGE, AK
    ZIP 99515
  • Phone: (907) 334-6468

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NPI Details

SUPREME HOME LLC is a custodial care facility in Anchorage, AK. The provider is a facility providing care that serves to assist an individual in the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, and using the toilet, preparation of special diets, and supervision of medication that usually can be self-administered. Custodial care essentially is personal care that does not require the continuing attention of trained medical or paramedical personnel. SUPREME HOME LLC NPI is 1033617881. The provider is registered as an organization entity type.

The provider's business location address is:

1735 MINERVA WAY
ANCHORAGE, AK
ZIP 99515-490
Phone: (907) 334-6468
Fax: (907) 868-4670

The provider's authorized official is Ajoke Olohima Walker Kolawole .
The authorized official title is Administrator and has the following contact phone number (907) 830-6959.

The enumeration date for this NPI number is 1/26/2018 and was last updated on 1/26/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityNo
23104A0630XAssisted Living FacilityAssisted Living, Behavioral DisturbancesNo
3311Z00000XCustodial Care FacilityALASKAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11030505MEDICAIDALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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