Provider Demographics
NPI:1093869323
Name:RIO BRAVO HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:RIO BRAVO HEALTH SYSTEM LLC
Other - Org Name:MAVERICK HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:830-773-5330
Mailing Address - Street 1:2822 N VETERANS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6697
Mailing Address - Country:US
Mailing Address - Phone:830-773-5330
Mailing Address - Fax:830-773-4078
Practice Address - Street 1:2822 N VETERANS BLVD STE A
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6697
Practice Address - Country:US
Practice Address - Phone:830-773-5330
Practice Address - Fax:830-773-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008267251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1093869323Medicaid
TX088263102Medicaid
TX001012468Medicaid