Provider Demographics
NPI:1710980040
Name:SU CASA HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:SU CASA HEALTH CARE SERVICES LLC
Other - Org Name:SU CASA HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADM, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELVA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:915-781-1882
Mailing Address - Street 1:9220 MCCOMBS ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-7443
Mailing Address - Country:US
Mailing Address - Phone:915-781-1882
Mailing Address - Fax:915-781-1883
Practice Address - Street 1:9220 MCCOMBS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-7443
Practice Address - Country:US
Practice Address - Phone:915-781-1882
Practice Address - Fax:915-781-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009044251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453174Medicare ID - Type UnspecifiedHOME HEALTH