Provider Demographics
NPI:1245232149
Name:HOSPICE BRAZOS VALLEY, INC.
Entity Type:Organization
Organization Name:HOSPICE BRAZOS VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-821-2266
Mailing Address - Street 1:502 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-2426
Mailing Address - Country:US
Mailing Address - Phone:979-821-2266
Mailing Address - Fax:
Practice Address - Street 1:502 W 26TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-2426
Practice Address - Country:US
Practice Address - Phone:979-821-2266
Practice Address - Fax:979-821-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2186251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2037Medicaid
TX2186OtherDEPT OF AGING
TX2186OtherDEPT OF AGING