Provider Demographics
NPI:1073940540
Name:COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Entity Type:Organization
Organization Name:COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Other - Org Name:COMMUNITY ACTION INTEGRATION CENTER-TAFT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-664-0145
Mailing Address - Street 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4822
Mailing Address - Country:US
Mailing Address - Phone:361-664-0145
Mailing Address - Fax:361-664-2248
Practice Address - Street 1:201 ROOTS AVE
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:TX
Practice Address - Zip Code:78390-3059
Practice Address - Country:US
Practice Address - Phone:361-528-4516
Practice Address - Fax:361-528-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741833Medicare Oscar/Certification