Provider Demographics
NPI:1003157223
Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC
Entity Type:Organization
Organization Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC
Other - Org Name:GRIMES COUNTY COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-846-1100
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:
Practice Address - Street 1:1905 DOVE CROSSING LN
Practice Address - Street 2:#C
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-5272
Practice Address - Country:US
Practice Address - Phone:936-825-0000
Practice Address - Fax:936-825-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08203363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty