MEDICARE: HOSPICE BRAZOS VALLEY, INC.

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	2186	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	2186	OTHER	TX	DEPT OF AGING

General Provider Information

NPI Number	:	1245232149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE BRAZOS VALLEY, INC.

Provider Business Mailing Address
First Line	:	502 W 26TH ST
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77803-2426
Country	:	US
Telephone Number	:	979-821-2266
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 W 26TH ST
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77803-2426
Country	:	US
Telephone Number	:	979-821-2266
Fax Number	:	979-821-2763

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MRS. LISA MCNAIR
Credential	:
Telephone Number	:	979-821-2266

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	12/13/2022

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