Provider Demographics
NPI:1699831685
Name:SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC.
Entity Type:Organization
Organization Name:SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC.
Other - Org Name:COMMUNITY ACTION HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:806-894-7872
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-0610
Mailing Address - Country:US
Mailing Address - Phone:806-894-6104
Mailing Address - Fax:806-897-0835
Practice Address - Street 1:410 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-4044
Practice Address - Country:US
Practice Address - Phone:806-894-7872
Practice Address - Fax:806-894-1621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000021100Medicaid
TX000652300Medicaid