Provider Demographics
NPI:1841738580
Name:SU CASA ADULT FOSTER HOME
Entity Type:Organization
Organization Name:SU CASA ADULT FOSTER HOME
Other - Org Name:SU CASA ADULT CARE SUPPLY
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:915-503-5107
Mailing Address - Street 1:12462 PASEO DE ARCO CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5669
Mailing Address - Country:US
Mailing Address - Phone:915-208-3163
Mailing Address - Fax:915-503-5825
Practice Address - Street 1:12462 PASEO DE ARCO CT
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-5669
Practice Address - Country:US
Practice Address - Phone:915-208-3163
Practice Address - Fax:915-503-5825
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SU CASA ADULT FOSTER HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225232311ZA0620X, 313M00000X
332B00000X, 343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle