Provider Demographics
NPI:1134307515
Name:RIO VALLEY HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:RIO VALLEY HEALTHCARE SERVICES, LLC
Other - Org Name:FORTE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUMGARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-590-8886
Mailing Address - Street 1:4502 CENTERVIEW
Mailing Address - Street 2:STE 225
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1314
Mailing Address - Country:US
Mailing Address - Phone:210-590-8886
Mailing Address - Fax:210-590-8887
Practice Address - Street 1:4502 CENTERVIEW STE 225
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228
Practice Address - Country:US
Practice Address - Phone:210-590-8886
Practice Address - Fax:210-590-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2176414-01Medicaid