Supreme Home LLC

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

SUPREME HOME LLC

Practice address

1735 Minerva Way
Anchorage, AK 99515-1490

Phone

(907) 334-6468

Fax

(907) 868-4670

NPI assigned

Jan 26, 2018

Last updated

Jan 26, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Ajoke Olohima Walker Kolawole, BA, C.N.A

Title

Administrator

Phone

(907) 830-6959

Specialties & licenses 3

Addresses

Other identifiers 1

Tax ID family

Supreme Home LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Alliance Care

  • Case Manager/Care Coordinator
  • Anchorage, AK
  • NPI 1831365220
  NPD tax ID
• Supreme Home LLC

  • Custodial Care Facility
  • Anchorage, AK
  • NPI 1891294153
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ajoke Olohima Walker, B.A ,C.N.A

  • Assisted Living Facility
  • Anchorage, AK
  • NPI 1588784557
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516924800000",
    "number": "1033617881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 MINERVA WAY",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995151490",
            "telephone_number": "907-334-6468",
            "fax_number": "907-868-4670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1735 MINERVA WAY",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995151490",
            "telephone_number": "907-334-6468",
            "fax_number": "907-868-4670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-26",
        "last_updated": "2018-01-26",
        "status": "A",
        "authorized_official_last_name": "WALKER KOLAWOLE",
        "authorized_official_first_name": "AJOKE",
        "authorized_official_middle_name": "OLOHIMA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "907-830-6959",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BA, C.N.A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "AK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1030505",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eric S Suoja, PAC
• Reed Supe, PHARMD, RPH
• Sara Supe, PHARMD, RPH
• Superior Community Care LLC (Superior Community Care)
• Supernova Advocates LLC
• Supreme Home LLC
• Surgery Assistants of Alaska LLC
• Surgical Specialists of Alaska
• Jennifer Nicole Surma
• Susan Canafax, FNP

• Custodial Care Facility in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Custodial Care Facility in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.