Provider Demographics
NPI:1437328150
Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Entity Type:Organization
Organization Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Other - Org Name:BVCAA, INC - HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-846-1100
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:#100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:1651 ROCK PRAIRIE RD
Practice Address - Street 2:STE. #102
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8346
Practice Address - Country:US
Practice Address - Phone:979-693-0740
Practice Address - Fax:979-693-7446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-27
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821185299OtherNPI AGENCY
TX191979701Medicaid
TX1437328150OtherNPI GROUP PEDS