Provider Demographics
NPI:1598775033
Name:MAGIC VALLEY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:MAGIC VALLEY HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY JAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGGONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-365-4672
Mailing Address - Street 1:1325 S 77 SUNSHINESTRIP
Mailing Address - Street 2:STE 217
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7465
Mailing Address - Country:US
Mailing Address - Phone:956-365-4672
Mailing Address - Fax:956-365-4676
Practice Address - Street 1:1325 S 77 SUNSHINESTRIP
Practice Address - Street 2:STE 217
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7465
Practice Address - Country:US
Practice Address - Phone:956-365-4672
Practice Address - Fax:956-365-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009269251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679192Medicare Oscar/Certification