Supreme Rehab Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

638089 Issued in MI

Legal business name

SUPREME REHAB INC

Practice address

29930 W 12 Mile Rd Ste 3
Farmington Hills, MI 48334-3983

Phone

(248) 862-2512

Fax

(248) 862-2145

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Naseem Ahmed KhanNPI 1417169798

Title

Owner / Administrator

Phone

(248) 214-1234

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• SUPREME HOME CARE AND REHAB INC Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Home health agency certification: CCN 237609

Legal name

SUPREME REHAB INC

Doing business as

SUPREME HOME CARE & REHAB

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jun 30, 2006

Last certification

Apr 19, 2019

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Oct 10, 1997 in MI

Enrollment address

29930 W 12 Mile Rd
Ste 3
Farmington Hills, MI 48334-3983
HHA Branch

Listed as

Supreme Home Care & RehabCCN 237609

Ownership

Proprietary

Certified

Jun 30, 2006

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Physical therapy, Occupational therapy

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.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Naseem Ahmed Khan, PHYSICAL THERAPIST

  • Physical Therapist
  • Farmington Hills, MI
  • NPI 1417169798

  5% Or Greater Direct Ownership Interest, Corporate Director, W-2 Managing Employee

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Naseem Ahmed Khan, PHYSICAL THERAPIST

  • Physical Therapist
  • Farmington Hills, MI
  • NPI 1417169798
  NPD Authorized official

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650067200000",
    "number": "1477627115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29930 W 12 MILE RD STE 3",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343983",
            "telephone_number": "248-862-2512",
            "fax_number": "248-862-2145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29930 W 12 MILE RD STE 3",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343983",
            "telephone_number": "248-862-2512",
            "fax_number": "248-862-2145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "38525 8 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Livonia",
            "state": "MI",
            "postal_code": "481521012",
            "country_code": "US",
            "telephone_number": "734-591-5920",
            "fax_number": "734-591-5922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUPREME REHAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2022-04-16",
        "certification_date": "2022-04-16",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "NASEEM",
        "authorized_official_middle_name": "AHMED",
        "authorized_official_title_or_position": "OWNER / ADMINISTRATOR",
        "authorized_official_telephone_number": "248-214-1234"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MI",
            "license": "638089",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "4105160001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "0E828",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2039402",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUPREME HOME CARE AND REHAB INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SUPREME HOME CARE AND REHAB INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jovi Sunn
• Carlos Suntecun
• Sarah Suntken
• Superior Family Dental
• Mary Jane Supnet
• Diana Suprice
• Brianna Surdell
• Phyllis A Surma, RN
• Kathryn Surnow, MPH, RD
• Myra Surratt

• Home Health Agency in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• Home Health Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2022; 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.