Provider Demographics
NPI:1538303011
Name:COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Entity Type:Organization
Organization Name:COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DRIECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:361-664-0145
Mailing Address - Street 1:PO BOX 1820
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78333-1820
Mailing Address - Country:US
Mailing Address - Phone:361-664-0145
Mailing Address - Fax:361-664-2248
Practice Address - Street 1:1400 S ST MARYS ST
Practice Address - Street 2:
Practice Address - City:FALFURRIAS
Practice Address - State:TX
Practice Address - Zip Code:78355-5037
Practice Address - Country:US
Practice Address - Phone:361-664-0145
Practice Address - Fax:361-664-2248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-28
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QW12OtherUNSPECIFIIED ID- TYPE MEDICARE
TX205224301Medicaid