Provider Demographics
NPI:1003834953
Name:BRAZOS VALLEY HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:BRAZOS VALLEY HOME HEALTH SERVICES, LLC
Other - Org Name:GENEVA G. GARCIA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:979-485-8252
Mailing Address - Street 1:3014 NORMAND DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5740
Mailing Address - Country:US
Mailing Address - Phone:979-485-8252
Mailing Address - Fax:979-485-8252
Practice Address - Street 1:3014 NORMAND DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5740
Practice Address - Country:US
Practice Address - Phone:979-485-8252
Practice Address - Fax:979-485-8252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAZOS VALLEY HOME HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009350251E00000X
TX011108251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673123Medicare UPIN