Provider Demographics
NPI:1144234501
Name:ALVIN COMMUNITY HEALTH ENDEAVOR
Entity Type:Organization
Organization Name:ALVIN COMMUNITY HEALTH ENDEAVOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:WILLIS
Authorized Official - Last Name:BENEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:281-331-2888
Mailing Address - Street 1:416 S JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-2747
Mailing Address - Country:US
Mailing Address - Phone:281-331-2888
Mailing Address - Fax:281-331-2889
Practice Address - Street 1:416 S JOHNSON ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-2747
Practice Address - Country:US
Practice Address - Phone:281-331-2888
Practice Address - Fax:281-331-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1687022-01Medicaid
TX8C9966Medicare ID - Type Unspecified
TX1687022-01Medicaid