Active NPI
Supreme Home Health Services Inc
- Home Health Agency
- Monroe, LA
National Provider Identifier
1225135437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 121
- Legal business name
- SUPREME HOME HEALTH SERVICES INC
- Practice address
- 1110 Jackson St
Monroe, LA 71202-2024 - Phone
- (318) 323-5489
- Fax
- (318) 323-8602
- NPI assigned
- Sep 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Emily B Winston, R.N.
- Title
- C.E.O.
- Phone
- (318) 325-8863
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 121 | LA | Primary |
Addresses
Primary practice location
1110 Jackson St
Monroe, LA 71202-2024
Mailing address
1110 Jackson St
PO Box 3145
Monroe, LA 71202-2024
Phone (318) 323-5489
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H83053 | Other | LA | VANTAGE HEALTH PLAN, INC. |
| 10525 | Other | LA | INFLUENZA VACCINE |
| 33530 | Other | LA | BLUE CROSS BLUE SHIELD |
| 140095 | Medicaid | LA | |
| 1930033530Z | Other | LA | BLUE CROSS BLUE SHIELD KE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120430000317 | LA | Part A Provider - Home Health Agency | 4486816998 | Practice locations: Monroe, LA |
Home health agency certification: CCN 197095
- Legal name
- SUPREME HOME HEALTH SERVICES INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Sep 9, 1983
- Last certification
- May 31, 2018
- Ownership / control type
- Proprietary
- Organization structure
- Corporation
- Incorporated
- Sep 6, 1983 in LA
- Enrollment address
- 1110 Jackson Street
Monroe, LA 71202-2024
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Supreme Home Health Service Inc
- Overall star rating
- Ownership
- Proprietary
- Certified
- Sep 9, 1983
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider Directory- Tax ID family
- Supreme Home Health Services Inc
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Custodial Care Facility
- Monroe, LA
- NPI 1003082421
-
- Custodial Care Facility
- Monroe, LA
- NPI 1669566675
-
- Home Health Agency
- Monroe, LA
- NPI 1700056322
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Carolyn Benjamin | 5% Or Greater Direct Ownership Interest | Sep 6, 1983 | 45% |
| Emily Winston | 5% Or Greater Direct Ownership Interest | Sep 6, 1983 | 55% |
| Corporate Officer | Sep 6, 1983 | 30% | |
| Corporate Director | Sep 6, 1983 | 30% | |
| W-2 Managing Employee | Sep 6, 1983 | 30% |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1225135437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1110 JACKSON ST",
"address_2": "PO BOX 3145",
"city": "MONROE",
"state": "LA",
"postal_code": "712022024",
"telephone_number": "318-323-5489",
"fax_number": "318-323-8602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 JACKSON ST",
"city": "MONROE",
"state": "LA",
"postal_code": "712022024",
"telephone_number": "318-323-5489",
"fax_number": "318-323-8602"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SUPREME HOME HEALTH SERVICES INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-20",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "WINSTON",
"authorized_official_first_name": "EMILY",
"authorized_official_middle_name": "B",
"authorized_official_title_or_position": "C.E.O.",
"authorized_official_telephone_number": "318-325-8863",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "R.N."
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "LA",
"license": "121",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VANTAGE HEALTH PLAN, INC.",
"identifier": "H83053",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INFLUENZA VACCINE",
"identifier": "10525",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "33530",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "140095",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD KE",
"identifier": "1930033530Z",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.