Provider Demographics
NPI:1366491706
Name:RIO GRANDE HOME HEALTH AGENCY, INC
Entity Type:Organization
Organization Name:RIO GRANDE HOME HEALTH AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-423-7100
Mailing Address - Street 1:630 N ED CAREY DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7506
Mailing Address - Country:US
Mailing Address - Phone:956-423-7100
Mailing Address - Fax:956-423-7241
Practice Address - Street 1:630 N ED CAREY DR STE A
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7506
Practice Address - Country:US
Practice Address - Phone:956-423-7100
Practice Address - Fax:956-423-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003055251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001003408Medicaid
TX000620400Medicaid
TX000080500Medicaid
TX001003407Medicaid
TX001003409Medicaid
TX001003404Medicaid
TX0235129-01Medicaid
TX001003405Medicaid
TX001003406Medicaid