Provider Demographics
NPI:1891673935
Name:SUCCOR ENTERPRISE NATIONAL ASSOCIATION
Entity type:Organization
Organization Name:SUCCOR ENTERPRISE NATIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SOTERO
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:586-565-0977
Mailing Address - Street 1:PO BOX 40261
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-0261
Mailing Address - Country:US
Mailing Address - Phone:586-565-0977
Mailing Address - Fax:
Practice Address - Street 1:220 W CONGRESS ST FL 2
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3289
Practice Address - Country:US
Practice Address - Phone:586-565-0977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
No347C00000XTransportation ServicesPrivate Vehicle