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General NPI Number Information
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NPI Number | 1043633746
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Entity Type | Organization
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Legal Business Name | HOSPICE BRAZOS VALLEY, INC.
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Dates
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Enumeration Date | 01/31/2014
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | 502 W 26TH ST
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City | BRYAN
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State | TX
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Zip | 77803-2426
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Country | US
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Telephone | 979-821-2266
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Fax |
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Provider Business Mailing Address
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Address Line | 502 W 26TH ST
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City | BRYAN
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State | TX
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Zip | 77803-2426
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Country | US
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Telephone | 979-821-2266
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. CRAIG BORCHARDT
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Credential | PH.D.
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Telephone | 979-821-2266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 2186
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License Number State | TX
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