Provider Demographics
NPI:1750578662
Name:BRAZOS VALLEY HOME MEDICAL EQUIPMENT, LLC
Entity type:Organization
Organization Name:BRAZOS VALLEY HOME MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-485-8252
Mailing Address - Street 1:3900 STATE HIGHWAY 6 S
Mailing Address - Street 2:STE 110
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5831
Mailing Address - Country:US
Mailing Address - Phone:979-485-8252
Mailing Address - Fax:979-485-8171
Practice Address - Street 1:3900 STATE HIGHWAY 6 S
Practice Address - Street 2:STE 110
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5831
Practice Address - Country:US
Practice Address - Phone:979-485-8252
Practice Address - Fax:979-485-8171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAZOS VALLEY HOME HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0095669332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies