Provider Demographics
NPI:1548528219
Name:RIVER SOUTH HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:RIVER SOUTH HEALTHCARE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:H
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-459-8259
Mailing Address - Street 1:912 TESORO AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO VIEJO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9534
Mailing Address - Country:US
Mailing Address - Phone:956-982-2000
Mailing Address - Fax:
Practice Address - Street 1:912 TESORO AVE
Practice Address - Street 2:
Practice Address - City:RANCHO VIEJO
Practice Address - State:TX
Practice Address - Zip Code:78575-9534
Practice Address - Country:US
Practice Address - Phone:956-982-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3288383Medicaid