Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Supreme Independence Room and Board

Organization Lodging Provider · NPI 1972267870

Supreme Independence Room and Board is a Lodging Provider in Detroit, Michigan. Registered with an NPI since 2021.

In the registry since
2021

Practice location Address checks out

12844 Broadstreet Ave
Detroit, MI 48238-3250
Phone: (313) 459-9538
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Lodging Provider (primary) Taxonomy 177F00000X

Record details

NPI number1972267870
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official James Blake — Owner · (810) 660-1892
NPI enumeratedOctober 26, 2021
Last updated in NPPESOctober 26, 2021
Certification dateOctober 26, 2021
Mailing address36306 Dominion Cir, Sterling Heights, MI 48310-7458

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