Supreme Habilitative Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

SUPREME HABILITATIVE SERVICES LLC

Practice address

100 S Ashley Dr Ste 600
Tampa, FL 33602-5300

Phone

(813) 381-0595

NPI assigned

Jun 28, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Rackaye J Simmons

Title

Ceo

Phone

(866) 751-8330

Specialties & licenses 6

Addresses

Other identifiers 1

Other names 1

• Supreme Habilitative Services Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637971200000",
    "number": "1730759168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S ASHLEY DR STE 600",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336025300",
            "telephone_number": "866-751-8330",
            "fax_number": "813-922-0553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S ASHLEY DR STE 600",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336025300",
            "telephone_number": "813-381-0595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME HABILITATIVE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-11-27",
        "certification_date": "2021-11-27",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "RACKAYE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "866-751-8330",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "INFO@SUPREMECARES.ORG",
            "affiliation": "N",
            "endpointDescription": "EMAIL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EMAIL",
            "address_1": "100 S Ashley Dr Ste 600",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336025300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Supreme Habilitative Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Health Agency in Tampa, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2021; 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.