Provider Demographics
NPI:1396182739
Name:COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Entity Type:Organization
Organization Name:COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Other - Org Name:COMMUNITY ACTION SCHOOL BASE HEALTH CENTER
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:
Practice Address - Street 1:502 E. SAN PATRICIO
Practice Address - Street 2:
Practice Address - City:MATHIS
Practice Address - State:TX
Practice Address - Zip Code:78368-2266
Practice Address - Country:US
Practice Address - Phone:361-547-4121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-24
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190685101Medicaid
671879Medicare PIN