Provider Demographics
NPI:1669763934
Name:ROCK BRIDGE HOME HEALTH AGENCY, INC
Entity type:Organization
Organization Name:ROCK BRIDGE HOME HEALTH AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDESMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-287-9991
Mailing Address - Street 1:3509 W. UNIVERSITY DR.
Mailing Address - Street 2:SUITE #4
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2812
Mailing Address - Country:US
Mailing Address - Phone:956-287-9991
Mailing Address - Fax:956-287-9994
Practice Address - Street 1:3509 W. UNIVERSITY DR.
Practice Address - Street 2:SUITE #4
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-2812
Practice Address - Country:US
Practice Address - Phone:956-287-9991
Practice Address - Fax:956-287-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011811251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679507OtherMEDICARE ID-TYPE UNSPECIFIED
TX1830275Medicaid