Provider Demographics
NPI:1437215787
Name:SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC.
Entity Type:Organization
Organization Name:SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC.
Other - Org Name:COMMUNITY ACTION VFI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:806-894-6104
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:411 AUSTIN ST
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-0610
Mailing Address - Country:US
Mailing Address - Phone:806-894-6104
Mailing Address - Fax:806-897-0835
Practice Address - Street 1:411 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-4733
Practice Address - Country:US
Practice Address - Phone:806-894-6104
Practice Address - Fax:806-897-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
TX251X00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001003550Medicaid