OrganizationSupreme Home Care Agency Of Ny Inc(<Unavail>)Home HealthAgenciesPractice Address15405 Northern Blvd Fl 3, Flushing, NY 11354-6724(718) 888-0855PECOS EnrollmentBased on the most recent information from CMS, provider Supreme Home Care Agency Of Ny Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1275076580Provider TypeOrganizationFull NameSupreme Home Care Agency Of Ny IncOther Name<Unavail>SubpartNoEnumeration Date11/18/2016Last Updated9/5/2025Contact InformationPractice LocationPractice Address15405 Northern Blvd Fl 3, Flushing, NY 11354-6724Phone(718) 888-0855Fax(718) 353-9212Mailing LocationMailing Address15405 Northern Blvd Fl 3, Flushing, NY 11354-6724Phone(718) 888-0855Fax(718) 353-9212Authorized OfficialNameLee, Youngsoon (Ceo)Phone(718) 888-0855Provider TaxonomiesCodeDescriptionLicenseCode251E00000XPrimaryDescriptionHome HealthAgenciesLicense1935L001New YorkProvider IdentifiersIDDescriptionIssuerID04505657DescriptionMedicaidIssuerUnlistedNew York