Provider Demographics
NPI:1508512260
Name:MAGIC VALLEY HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:MAGIC VALLEY HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEMAH
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:EGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-779-7854
Mailing Address - Street 1:14217 AMISTAD CIR
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0688
Mailing Address - Country:US
Mailing Address - Phone:346-779-7854
Mailing Address - Fax:
Practice Address - Street 1:14217 AMISTAD CIR
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-0688
Practice Address - Country:US
Practice Address - Phone:346-779-7854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000000000Medicaid