Provider Demographics
NPI:1467501551
Name:VALLEY ANGELS HOME HEALTH, LLC.
Entity Type:Organization
Organization Name:VALLEY ANGELS HOME HEALTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:956-541-4400
Mailing Address - Street 1:5250 RIDGELINE DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3882
Mailing Address - Country:US
Mailing Address - Phone:956-541-4400
Mailing Address - Fax:956-541-4924
Practice Address - Street 1:315 JOSE MARTI BLVD STE A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-2968
Practice Address - Country:US
Practice Address - Phone:956-541-4400
Practice Address - Fax:956-541-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673170251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1745671Medicaid
TX1745671Medicaid