1366491706 NPI number — RIO GRANDE HOME HEALTH AGENCY, INC

Table of content: (NPI 1366491706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366491706 NPI number — RIO GRANDE HOME HEALTH AGENCY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIO GRANDE HOME HEALTH AGENCY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366491706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 N ED CAREY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78550-7506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-423-7100
Provider Business Mailing Address Fax Number:
956-423-7241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 N ED CAREY DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-7506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-423-7100
Provider Business Practice Location Address Fax Number:
956-423-7241
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOLINA
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
956-423-7100

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  003055 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001003408 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000620400 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000080500 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001003407 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001003409 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001003404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0235129-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001003405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001003406 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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