Provider Demographics
NPI:1609979137
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:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-664-0145
Mailing Address - Street 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4822
Mailing Address - Country:US
Mailing Address - Phone:361-664-0145
Mailing Address - Fax:361-668-3319
Practice Address - Street 1:204 E 1ST ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4822
Practice Address - Country:US
Practice Address - Phone:361-664-0145
Practice Address - Fax:361-668-3319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 225100000X, 225X00000X, 235Z00000X, 252Y00000X
TXDT02859133V00000X
TXDT05385133V00000X
TX1141653225100000X
TX1063204225100000X
TX1103976225100000X
TX109156225X00000X
TX209746225X00000X
TX100504235Z00000X
TX102318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX003773102Medicaid
TX017437701Medicaid
TX115979004Medicaid
TX063190501Medicaid