Provider Demographics
NPI:1275620551
Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Entity Type:Organization
Organization Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Other - Org Name:ROBERTSON 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:M
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-846-1100
Mailing Address - Street 1:1002 W BROWN ST
Mailing Address - Street 2:
Mailing Address - City:HEARNE
Mailing Address - State:TX
Mailing Address - Zip Code:77859-3063
Mailing Address - Country:US
Mailing Address - Phone:979-279-0701
Mailing Address - Fax:979-279-0504
Practice Address - Street 1:1002 W BROWN ST
Practice Address - Street 2:
Practice Address - City:HEARNE
Practice Address - State:TX
Practice Address - Zip Code:77859-3063
Practice Address - Country:US
Practice Address - Phone:979-279-0701
Practice Address - Fax:979-279-0504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAZOS VALLEY COMMUNITY ACTION AGENCY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154467803Medicaid
TX154467803Medicaid