Healthcare Provider Details

I. General information

NPI: 1245508407
Provider Name (Legal Business Name): RGV ELDER HEALTH SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 HWY 107
MISSION TX
78573-8247
US

IV. Provider business mailing address

PO BOX 1893
MISSION TX
78573-0031
US

V. Phone/Fax

Practice location:
  • Phone: 956-583-8013
  • Fax: 956-583-5120
Mailing address:
  • Phone: 956-583-8013
  • Fax: 956-583-5120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number131994
License Number StateTX

VIII. Authorized Official

Name: MR. BENJAMIN MADRIGALES
Title or Position: PRESIDENT
Credential: LVN
Phone: 956-533-6825