MEDICARE: SU CASA HEALTH CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	009044	TX

General Provider Information

NPI Number	:	1710980040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SU CASA HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	9220 MCCOMBS ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-7443
Country	:	US
Telephone Number	:	915-781-1882
Fax Number	:	915-781-1883

Provider Business Practice Location Address
First Line	:	9220 MCCOMBS ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-7443
Country	:	US
Telephone Number	:	915-781-1882
Fax Number	:	915-781-1883

Authorized Official
Title or Position	:	ADM, OWNER
Name	:	ELVA ELENA BROWN
Credential	:	RN
Telephone Number	:	915-781-1882

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	10/13/2011

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Directions to “SU CASA HEALTH CARE SERVICES LLC ” Practice Location

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