Provider Demographics
NPI:1508500133
Name:SUCASA HEALTH LLC
Entity Type:Organization
Organization Name:SUCASA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ANSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:877-655-8500
Mailing Address - Street 1:8208 KIMBERSHELL PL
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-8436
Mailing Address - Country:US
Mailing Address - Phone:877-655-8500
Mailing Address - Fax:888-966-3819
Practice Address - Street 1:8208 KIMBERSHELL PL
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-8436
Practice Address - Country:US
Practice Address - Phone:877-655-8500
Practice Address - Fax:888-966-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty