Provider Demographics
NPI:1467483362
Name:CONCHO VALLEY HHC OF WEST TX LLC
Entity Type:Organization
Organization Name:CONCHO VALLEY HHC OF WEST TX LLC
Other - Org Name:CONCHO VALLEY HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-944-8916
Mailing Address - Street 1:PO BOX 3247
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-3247
Mailing Address - Country:US
Mailing Address - Phone:235-944-8916
Mailing Address - Fax:325-944-8929
Practice Address - Street 1:430 W BEAUREGARD AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903
Practice Address - Country:US
Practice Address - Phone:235-944-8916
Practice Address - Fax:325-944-8929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008619251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008619OtherSTATE LICENSE NUMBER
TX679383Medicare Oscar/Certification