MEDICARE: SUCASA PERSONAL HOMECARE 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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1992419360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUCASA PERSONAL HOMECARE LLC

Provider Business Mailing Address
First Line	:	3430 E FLAMINGO RD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5064
Country	:	US
Telephone Number	:	702-348-9453
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 E FLAMINGO RD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5064
Country	:	US
Telephone Number	:	702-348-9453
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. GLEN SCHLOSSER
Credential	:
Telephone Number	:	702-489-4533

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	01/10/2023

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