Provider Demographics
NPI:1144231051
Name:RIO VALLEY HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:RIO VALLEY HEALTHCARE SERVICES, LLC
Other - Org Name:RIO MED 21
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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:956-372-8974
Mailing Address - Street 1:4502 CENTERVIEW STE 225
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1317
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:78228-1317
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:2006-08-10
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009506251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175127301Medicaid
TX175127301Medicaid