Healthcare Provider Details

I. General information

NPI: 1679523476
Provider Name (Legal Business Name): BIG BEND REGIONAL MEDICAL CENTER HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N HIGHWAY 118
ALPINE TX
79830-2002
US

IV. Provider business mailing address

2600 N HIGHWAY 118
ALPINE TX
79830-2002
US

V. Phone/Fax

Practice location:
  • Phone: 432-837-3467
  • Fax: 432-837-0077
Mailing address:
  • Phone: 432-837-3467
  • Fax: 432-837-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KEISHA ANNETTE HERNANDEZ
Title or Position: BILLER
Credential:
Phone: 432-837-3467