Provider Demographics
NPI:1083301436
Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Entity type:Organization
Organization Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-383-2348
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-810-8148
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:625 W BELTON AVE
Practice Address - Street 2:RM 25
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2813
Practice Address - Country:US
Practice Address - Phone:512-883-4370
Practice Address - Fax:979-731-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)