Provider Demographics
NPI:1457019895
Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Entity Type:Organization
Organization Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-383-2340
Mailing Address - Street 1:1500 UNIVERSITY DR E STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-383-3418
Mailing Address - Fax:
Practice Address - Street 1:550 COUNTY ROAD 307
Practice Address - Street 2:RM 424
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836
Practice Address - Country:US
Practice Address - Phone:979-567-2710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)