Supreme Family Care Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

FCL-032-137 Issued in NC

Legal business name

SUPREME FAMILY CARE HOME

Practice address

1120 Benning St
Durham, NC 27703-1504

Phone

(919) 973-3724

NPI assigned

Nov 17, 2014

Organization subpart

No

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

Authorized official

Name

Julius Ajayi

Title

Administrator

Phone

(919) 225-2056

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1416182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416182400000",
    "number": "1639575723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 BENNING ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277031504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 BENNING ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277031504",
            "telephone_number": "919-973-3724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME FAMILY CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-17",
        "last_updated": "2014-11-17",
        "status": "A",
        "authorized_official_last_name": "AJAYI",
        "authorized_official_first_name": "JULIUS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "919-225-2056"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL-032-137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Support Source of North Carolina
• Supportive Counseling Services, PLLC
• Jillian Brooke Supranowitz
• Supreme Care, Inc.
• Supreme Family Care Home
• Supreme Mobile Testing LLC
• Supreme Residential Care, LLC
• Amol Ashwin Sura, M.D.
• Nandana Surana, LPA
• Brandon Chase Surber, ATC

• Adult Care Home Facility in Durham, NC
• Providers in Durham, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; 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.