Supreme Home LLC

NPI #1033617881 in Anchorage, Alaska

Provider Information

NPI Number: 1033617881
Entity Type: Organization
Organization Name: Supreme Home LLC
Primary Specialty: Custodial Care Facility
Enumeration Date: Jan 26, 2018
Last Updated: Jan 26, 2018

Practice Location

Address: 1735 MINERVA WAY
City: Anchorage
State: Alaska
ZIP Code: 99515-1490
Phone: (907) 334-6468

Authorized Official

Name: MRS. AJOKE OLOHIMA WALKER KOLAWOLE, BA, C.N.A
Title: ADMINISTRATOR
Phone: (907) 830-6959

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Assisted Living Facility	310400000X
Assisted Living Facility - Assisted Living, Behavioral Disturbances — Assisted Living, Behavioral Disturbances	3104A0630X
Custodial Care Facility	311Z00000X	Primary

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