NPI 1104792183

Supreme Care Servicesllc

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Hyattsville, MD

Practice location

Address: 4738 68th Ave, Hyattsville, MD 20784-1400
Phone: (301) 814-1509
Fax: (301) 814-1509

Authorised official

Name: Korpo Kollie Johnson
Title: President
Phone: (301) 814-1509

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Maryland →

Registry record

NPI: 1104792183
Entity type: Organization
NPI issued: 15 Oct 2025
Record last updated: 8 Dec 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.