Supreme Love

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL098132 Issued in NC

Legal business name

SUPREME LOVE

Practice address

4232 Coghill Dr N
Wilson, NC 27896-9503

Phone

(252) 234-6163

Fax

(252) 234-6163

NPI assigned

Jun 11, 2009

Last updated

Jun 11, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Betty Forsythe

Title

Owner

Phone

(252) 234-6163

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244678400000",
    "number": "1891922217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4232 COGHILL DR N",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278969503",
            "telephone_number": "252-234-6163",
            "fax_number": "252-234-6163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4232 COGHILL DR N",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278969503",
            "telephone_number": "252-234-6163",
            "fax_number": "252-234-6163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME LOVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-11",
        "last_updated": "2009-06-11",
        "status": "A",
        "authorized_official_last_name": "FORSYTHE",
        "authorized_official_first_name": "BETTY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-234-6163"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL098132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ranjani Sunil
• Sunshine Homes
• Sunshine Prosthetics Inc
• Superior Living,LLC
• Supportive Living Solutions Corp
• Surgecenter of Wilson Limited Partnership
• Surgery Center of Wilson, LLC
• David John Surovchak, PA-C
• Sowmya K Suryanarayanan, M. D.
• Vijay Swahari, M.D.

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Wilson, NC
• Providers in Wilson, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2009; 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.