Supra Home Health Agency Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

SUPRA HOME HEALTH AGENCY INC

Practice address

14540 Ramona Blvd Ste 213
Baldwin Park, CA 91706-3386

Phone

(323) 240-3903

NPI assigned

May 14, 2021

Organization subpart

No

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

Authorized official

Name

Luisa M Rojas

Title

Ceo

Phone

(323) 240-3903

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 757371

Legal name

SUPRA HOME HEALTH AGENCY INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 3, 2023

Last certification

Jul 11, 2023

Organization structure

CorporationProprietary

Incorporated

Mar 18, 2021 in CA

Enrollment address

14540 Ramona Blvd
Ste 213
Baldwin Park, CA 91706-3386

Listed as

Supra Home Health Agency, Inc.CCN 757371

Ownership

-

Certified

Aug 3, 2023

Medicare certification status

ActiveFrom the Provider of Services file

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1620950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1073187977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14540 RAMONA BLVD STE 213",
            "city": "BALDWIN PARK",
            "state": "CA",
            "postal_code": "917063386",
            "telephone_number": "323-240-3903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14540 RAMONA BLVD STE 213",
            "city": "BALDWIN PARK",
            "state": "CA",
            "postal_code": "917063386",
            "telephone_number": "323-240-3903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPRA HOME HEALTH AGENCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-14",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "ROJAS",
        "authorized_official_first_name": "LUISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-240-3903"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "EMAIL",
            "affiliation": "N",
            "endpointDescription": "SUPRAHOMEHEALTHAGENCY@GMAIL.COM",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "14540 Ramona Blvd Ste 213",
            "city": "Baldwin Park",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917063386",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elise Sum
• Hao Sun, MD
• Yu Sun
• Debra Jo Sung, PT
• Chuck Suntalus, L.AC.
• Supra Hospice Inc.
• Lori Ann Switanowski, LMFT
• Sajjad Parvez Syed, MD
• Andrea Y Tam, OD
• Caren Tiffany Tam, PHARM.D.

• Home Health Agency in Baldwin Park, CA
• Providers in Baldwin Park, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.