Supreme Home LLC

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

SUPREME HOME LLC

Practice address

2600A Bryant Cir
Anchorage, AK 99507-3252

Phone

(907) 929-1141

Fax

(907) 868-4670

NPI assigned

Feb 1, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Ajoke Olohima Kolawole, B.A., CNA

Title

Administrator

Phone

(907) 830-6959

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Supreme Home LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Alliance Care

  • Case Manager/Care Coordinator
  • Anchorage, AK
  • NPI 1831365220
  NPD tax ID
• Supreme Home LLC

  • Custodial Care Facility
  • Anchorage, AK
  • NPI 1033617881
  NPD tax ID

Practitioners 1

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

• Ajoke Olohima Walker, B.A ,C.N.A

  • Assisted Living Facility
  • Anchorage, AK
  • NPI 1588784557
  NPD (past)

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

{
    "created_epoch": "1517443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517788800000",
    "number": "1891294153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 A BRYANT CIRCLE",
            "address_2": "P.O BOX 142764",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995142764",
            "telephone_number": "907-929-1141",
            "fax_number": "907-868-4670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600A BRYANT CIR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995073252",
            "telephone_number": "907-929-1141",
            "fax_number": "907-868-4670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-01",
        "last_updated": "2018-02-05",
        "status": "A",
        "authorized_official_last_name": "KOLAWOLE",
        "authorized_official_first_name": "AJOKE",
        "authorized_official_middle_name": "OLOHIMA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "907-830-6959",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "B.A., CNA"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "AK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1030505",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Reed Supe, PHARMD, RPH
• Sara Supe, PHARMD, RPH
• Superior Community Care LLC
• Supernova Advocates LLC
• Supreme Home LLC
• Surgery Assistants of Alaska LLC
• Surgical Specialists of Alaska
• Jennifer Nicole Surma
• Susan Canafax, FNP
• Susan Veatch Pettis

• Custodial Care Facility in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Custodial Care Facility in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2018; 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.