Provider Demographics
NPI:1992956056
Name:RIO VALLE HEALTH INC
Entity type:Organization
Organization Name:RIO VALLE HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESILE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RNC, MSN
Authorized Official - Phone:915-850-0375
Mailing Address - Street 1:7717 LOCKHEED DR
Mailing Address - Street 2:STE E
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-2464
Mailing Address - Country:US
Mailing Address - Phone:915-850-0375
Mailing Address - Fax:915-772-3580
Practice Address - Street 1:7717 LOCKHEED DR
Practice Address - Street 2:STE E
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2464
Practice Address - Country:US
Practice Address - Phone:915-850-0375
Practice Address - Fax:915-772-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
TX261883336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117343OtherPK