Provider Demographics
NPI:1932187069
Name:VILLAGE CHOICE HEALTHCARE INC
Entity Type:Organization
Organization Name:VILLAGE CHOICE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DARIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:409-838-5151
Mailing Address - Street 1:PO BOX 5668
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-5668
Mailing Address - Country:US
Mailing Address - Phone:409-838-5151
Mailing Address - Fax:409-838-6161
Practice Address - Street 1:5825 PHELAN BLVD STE 106
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6200
Practice Address - Country:US
Practice Address - Phone:409-838-5151
Practice Address - Fax:409-838-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167516701Medicaid
TX459375Medicare Oscar/Certification
TX459375Medicare UPIN