Provider Demographics
NPI:1164659587
Name:BRUSH COUNTRY HOME HEALTH, INC.
Entity Type:Organization
Organization Name:BRUSH COUNTRY HOME HEALTH, INC.
Other - Org Name:BRUSH COUNTRY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:956-765-1200
Mailing Address - Street 1:1002 PASEO DE TIBER STE A
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-7642
Mailing Address - Country:US
Mailing Address - Phone:956-765-1200
Mailing Address - Fax:956-765-1201
Practice Address - Street 1:1002 PASEO DE TIBER STE A
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-7642
Practice Address - Country:US
Practice Address - Phone:956-765-1200
Practice Address - Fax:956-765-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747609Medicare PIN