Supra Home Health, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

299992774 Issued in FL

Legal business name

SUPRA HOME HEALTH, INC.

Practice address

6720 Taft St
Hollywood, FL 33024-3903

Phone

(954) 443-6461

Fax

(954) 443-6462

NPI assigned

May 29, 2007

Last updated

Apr 17, 2020By 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

Mr. Davel Prieto

Title

Administrator

Phone

(954) 443-6461

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922209162. Details of each certification follow.

• CCN 109056 Home health agency · Active · Details

Home health agency certification: CCN 109056

Legal name

SUPRA HOME HEALTH, INC.

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Sep 23, 2008

Last certification

Sep 1, 2017

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Feb 12, 2007 in FL

Enrollment address

6720 Taft St
Hollywood, FL 33024-3903
HHA Branch

Listed as

Supra Home Health, IncCCN 109056 · All quality measures

Ownership

Proprietary

Certified

Sep 23, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Maria Del Carmen Alvarez, ARNP

  • Adult Health Nurse Practitioner
  • Hollywood, FL
  • NPI 1215265780
  NPD (past)
• Miguel E Gonzalez, MD

  • Internal Medicine Physician
  • Leesburg, FL
  • NPI 1750333480
  NPD (past)

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587081600000",
    "number": "1922209162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6720 TAFT ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330243903",
            "telephone_number": "954-443-6461",
            "fax_number": "954-443-6462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6720 TAFT ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330243903",
            "telephone_number": "954-443-6461",
            "fax_number": "954-443-6462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPRA HOME HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A",
        "authorized_official_last_name": "PRIETO",
        "authorized_official_first_name": "DAVEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "954-443-6461",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": "299992774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "651652100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "299992774",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sunshine Therapy Partners
• Superior Stores Discount Distributors, Inc. (Surgical World)
• Supported Strength, LLC
• Supportive ABA Therapy de LLC
• Supportive ABA Therapy FL LLC
• Supreme Speech Therapy Inc
• Christine Suraci, SLP
• Rajalakshmi Suresh, APRN, PMHNP-BC
• Surgery Center of Pembroke Pines, LLC (Broward Specialty Surgical Center)
• Surgical Consultants of Hollywood PA

• Home Health Agency in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Home Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.