MEDICARE: MICASA SUCASA

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1942922166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICASA SUCASA

Provider Business Mailing Address
First Line	:	780 ELKRIDGE LANDING RD STE 103
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-2911
Country	:	US
Telephone Number	:	410-227-8002
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 ELKRIDGE LANDING RD STE 103
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-2911
Country	:	US
Telephone Number	:	410-227-8002
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MS. MARCIA BAILEY
Credential	:
Telephone Number	:	410-227-8002

Provider Enumeration Date	:	09/14/2022
Last Update Date	:	09/14/2022

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