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General NPI Number Information
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NPI Number | 1801651179
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Entity Type | Organization
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Legal Business Name | SUCCOR HOMECARE AGENCY LLC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 3 COURTHOUSE LN STE 2
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City | CHELMSFORD
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State | MA
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Zip | 01824-1719
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Country | US
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Telephone | 617-686-9929
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Fax |
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Provider Business Mailing Address
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Address Line | 21 OLDE COMMON DR
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City | ATKINSON
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State | NH
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Zip | 03811-2177
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Country | US
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Telephone | 201-417-6533
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | EDMUND K AZIABOR
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Credential |
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Telephone | 201-417-6533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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