Provider Demographics
NPI:1801651179
Name:SUCCOR HOMECARE AGENCY LLC
Entity type:Organization
Organization Name:SUCCOR HOMECARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:K
Authorized Official - Last Name:AZIABOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-417-6533
Mailing Address - Street 1:21 OLDE COMMON DR
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NH
Mailing Address - Zip Code:03811-2177
Mailing Address - Country:US
Mailing Address - Phone:201-417-6533
Mailing Address - Fax:
Practice Address - Street 1:3 COURTHOUSE LN STE 2
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1719
Practice Address - Country:US
Practice Address - Phone:617-686-9929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health