Provider Demographics
NPI:1457366155
Name:BRAZOS VALLEY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:BRAZOS VALLEY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:KAKKANATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-723-8520
Mailing Address - Street 1:14014 COBALT GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-2092
Mailing Address - Country:US
Mailing Address - Phone:281-723-8520
Mailing Address - Fax:281-242-2775
Practice Address - Street 1:14014 COBALT GLEN DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-2092
Practice Address - Country:US
Practice Address - Phone:281-723-8520
Practice Address - Fax:281-242-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010584251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health