Provider Demographics
NPI:1225004526
Name:BRAZORIA COUNTY ASSOCIATION FOR CHILDREN'S HABILITATION
Entity Type:Organization
Organization Name:BRAZORIA COUNTY ASSOCIATION FOR CHILDREN'S HABILITATION
Other - Org Name:BACH
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-849-2447
Mailing Address - Street 1:120 E HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-4112
Mailing Address - Country:US
Mailing Address - Phone:979-849-2447
Mailing Address - Fax:979-848-8337
Practice Address - Street 1:120 E HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4112
Practice Address - Country:US
Practice Address - Phone:979-849-2447
Practice Address - Fax:979-848-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091740301Medicaid