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General NPI Number Information
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NPI Number | 1245232149
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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 | 08/11/2005
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Last Update Date | 12/13/2022
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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 | 979-821-2763
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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 | MRS. LISA MCNAIR
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Credential |
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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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 2186
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License Number State | TX
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