Provider Demographics
NPI:1043769292
Name:DEL RIO GRANDE HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:DEL RIO GRANDE HOME HEALTHCARE LLC
Other - Org Name:DEL RIO GRANDE HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-469-1108
Mailing Address - Street 1:1302 W GARZA ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-7053
Mailing Address - Country:US
Mailing Address - Phone:830-469-1108
Mailing Address - Fax:830-469-3051
Practice Address - Street 1:1302 W GARZA ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-7053
Practice Address - Country:US
Practice Address - Phone:830-469-1108
Practice Address - Fax:830-469-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 3747P1801X
TX17639253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX363199601Medicaid