Provider Demographics
NPI:1164502563
Name:SPANISH AMERICAN CIVIC ASSOCIATION FOR EQUALITY, INC
Entity Type:Organization
Organization Name:SPANISH AMERICAN CIVIC ASSOCIATION FOR EQUALITY, INC
Other - Org Name:NUESTRA CLINICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRAUPERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-509-3712
Mailing Address - Street 1:545 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4369
Mailing Address - Country:US
Mailing Address - Phone:717-293-4150
Mailing Address - Fax:717-399-4289
Practice Address - Street 1:545 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4369
Practice Address - Country:US
Practice Address - Phone:717-293-4150
Practice Address - Fax:717-399-4289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA362450261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007776330015Medicaid
PA028253Medicare ID - Type Unspecified