Supreme Wellness Recovery LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

SUPREME WELLNESS RECOVERY LLC

Practice address

603 Corporate Dr W
Langhorne, PA 19047-8013

Phone

(215) 874-3636

Fax

(215) 910-4350

NPI assigned

Apr 20, 2018

Organization subpart

No

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

Authorized official

Name

Nichole Breslin

Title

Project Director

Phone

(215) 874-3636

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1524182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678752000000",
    "number": "1558858969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 CORPORATE DR W",
            "city": "LANGHORNE",
            "state": "PA",
            "postal_code": "190478013",
            "telephone_number": "215-874-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 CORPORATE DR W",
            "city": "LANGHORNE",
            "state": "PA",
            "postal_code": "190478013",
            "telephone_number": "215-874-3636",
            "fax_number": "215-910-4350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME WELLNESS RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-20",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A",
        "authorized_official_last_name": "BRESLIN",
        "authorized_official_first_name": "NICHOLE",
        "authorized_official_title_or_position": "PROJECT DIRECTOR",
        "authorized_official_telephone_number": "215-874-3636"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alice Sui, OD
• Corey Alan Summers
• Summit Square Family Medicine,PC
• Superior Anesthesia LLC
• Jessica Lee Supperer, LPC
• Steven Sweig
• Ann Marie Swords, PA-C
• Jody Sysler, PH.D.
• Brian G Tait, CRNA
• Jay Chand Talluri, MD

• Substance Use Disorder Rehabilitation Clinic/Center in Langhorne, PA
• Providers in Langhorne, PA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.