Provider Demographics
NPI:1568519122
Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Entity Type:Organization
Organization Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Other - Org Name:LEON COUNTY COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
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
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 1:623 W LASSATER
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TX
Practice Address - Zip Code:75833-1959
Practice Address - Country:US
Practice Address - Phone:903-536-3687
Practice Address - Fax:903-536-7723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-05
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185649401Medicaid
TX000951606Medicaid
TX185649401Medicaid