Provider Demographics
NPI:1013153600
Name:RIO GRANDE VALLEY PHC/CBA, LLC
Entity Type:Organization
Organization Name:RIO GRANDE VALLEY PHC/CBA, LLC
Other - Org Name:UNIVERSAL PROVIDER SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAYTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-631-4421
Mailing Address - Street 1:612 W NOLANA AVE STE 570B
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3971
Mailing Address - Country:US
Mailing Address - Phone:956-631-4421
Mailing Address - Fax:956-631-5540
Practice Address - Street 1:612 W NOLANA AVE
Practice Address - Street 2:BLDG. 500 STE. 570-B
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-631-4421
Practice Address - Fax:956-631-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251E00000X
TX0167743747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome HealthGroup - Single Specialty