Provider Demographics
NPI:1689898249
Name:COMMUNITY MOTHER AND CHILD HEALTH CENTER
Entity Type:Organization
Organization Name:COMMUNITY MOTHER AND CHILD HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WHCNP
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, WHCNP
Authorized Official - Phone:361-570-1082
Mailing Address - Street 1:510 E RIO GRANDE ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6033
Mailing Address - Country:US
Mailing Address - Phone:361-570-1082
Mailing Address - Fax:
Practice Address - Street 1:510 E RIO GRANDE ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6033
Practice Address - Country:US
Practice Address - Phone:361-570-1082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595240261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health