Provider Demographics
NPI:1598415226
Name:AMIKIDS RIO GRANDE VALLEY, INC
Entity Type:Organization
Organization Name:AMIKIDS RIO GRANDE VALLEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL DIRECTOR-MENTAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW-HOPPOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:386-846-9017
Mailing Address - Street 1:5915 BENJAMIN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5239
Mailing Address - Country:US
Mailing Address - Phone:813-734-5678
Mailing Address - Fax:
Practice Address - Street 1:27615 BUENA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-4377
Practice Address - Country:US
Practice Address - Phone:956-233-5795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children