Provider Demographics
NPI:1992702732
Name:VAL VERDE HOSPITAL CORPORATION
Entity type:Organization
Organization Name:VAL VERDE HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:830-774-4580
Mailing Address - Street 1:PO BOX 1334
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78841-1334
Mailing Address - Country:US
Mailing Address - Phone:830-774-4580
Mailing Address - Fax:830-774-2485
Practice Address - Street 1:801 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4112
Practice Address - Country:US
Practice Address - Phone:830-774-4580
Practice Address - Fax:830-774-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007353251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2097Medicaid
TXHH6808OtherBLUE CROSS BLUE SHIELD
TX=========001OtherTRICARE PROVIDER
TX451604Medicare ID - Type UnspecifiedMEDICARE PROVIDER