MEDICARE: VAL VERDE HOSPITAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	007353	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	HH6808	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1992702732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAL VERDE HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 1334
Second Line	:
City	:	DEL RIO
State	:	TX
Zip	:	78841-1334
Country	:	US
Telephone Number	:	830-774-4580
Fax Number	:	830-774-2485

Provider Business Practice Location Address
First Line	:	801 N BEDELL AVE
Second Line	:
City	:	DEL RIO
State	:	TX
Zip	:	78840-4112
Country	:	US
Telephone Number	:	830-774-4580
Fax Number	:	830-774-2485

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. BONNIE M HENDERSON
Credential	:	RN
Telephone Number	:	830-774-4580

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	04/29/2010

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