Supreme Team LLC

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

SUPREME TEAM LLC

Doing business as

Longevity Personal Care Home

Practice address

1520 12TH St
Augusta, GA 30901-3676

Phone

(706) 364-4710

NPI assigned

Jul 2, 2012

Last updated

Jul 2, 2012By 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

Mrs. Caletha Taylor

Title

Manager

Phone

(706) 951-7514

Specialties & licenses 1

Addresses

Other names 1

• Longevity Personal Care Home Doing business as

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

{
    "created_epoch": "1341187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341187200000",
    "number": "1912261231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5327 WINDMILL PKWY",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308096651",
            "telephone_number": "706-951-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 12TH ST",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309013676",
            "telephone_number": "706-364-4710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME TEAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-02",
        "last_updated": "2012-07-02",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "CALETHA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "706-951-7514",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Longevity Personal Care Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Custodial Care Facility in Augusta, GA
• Providers in Augusta, GA by specialty
• Custodial Care Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; 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.