1083301436 NPI number — BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083301436 NPI number — BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083301436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 UNIVERSITY DR E STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEGE STATION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77840-2600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-383-2340
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 W BELTON AVE RM 25
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKDALE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76567-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-883-4370
Provider Business Practice Location Address Fax Number:
979-731-4570
Provider Enumeration Date:
04/18/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SABELLA
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
979-383-2340

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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