Supreme Care Wellness Group LLC

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

SUPREME CARE WELLNESS GROUP LLC

Practice address

1736 NW Cataluna Cir
Port Saint Lucie, FL 34986-5800

Phone

(561) 449-3147

NPI assigned

Feb 22, 2023

Organization subpart

No

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

Authorized official

Name

Jacolby Tillman

Title

Owner

Phone

(561) 449-3147

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1677024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677024000000",
    "number": "1497453948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1736 NW CATALUNA CIR",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349865800",
            "telephone_number": "561-449-3147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1736 NW CATALUNA CIR",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349865800",
            "telephone_number": "561-449-3147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME CARE WELLNESS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-22",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "JACOLBY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-449-3147"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmental Disabilities Clinic/Center in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; 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.