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SUPREME HOME LLC NPI 1891294153


NPI Information

NPI: 1891294153
Provider Name: SUPREME HOME LLC
Classification: Custodial Care Facility - 311Z00000X
Entity Type: Organization
Address:
2600A BRYANT CIR
ANCHORAGE, AK
ZIP 99507
Phone: (907) 929-1141
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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 1891294153. The provider is registered as an organization entity type.

The provider's business location address is:

2600A BRYANT CIR
ANCHORAGE, AK
ZIP 99507-252
Phone: (907) 929-1141
Fax: (907) 868-4670

The provider's authorized official is Ajoke Olohima 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 2/1/2018 and was last updated on 2/5/2018.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1311Z00000XCustodial 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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther 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: 11/14/2023

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