Provider Demographics
NPI:1982682522
Name:MCH OF RIO GRANDE VALLEY INC
Entity Type:Organization
Organization Name:MCH OF RIO GRANDE VALLEY INC
Other - Org Name:DEACONESS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISIONAL CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:F
Authorized Official - Last Name:POYTHRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-268-1842
Mailing Address - Street 1:PO BOX 16809
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-6809
Mailing Address - Country:US
Mailing Address - Phone:601-268-1842
Mailing Address - Fax:601-268-7898
Practice Address - Street 1:2552 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8070
Practice Address - Country:US
Practice Address - Phone:956-972-1920
Practice Address - Fax:956-972-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
459428Medicare ID - Type UnspecifiedFEDERAL