Provider Demographics
NPI:1821026394
Name:CENTRAL TEXAS COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:CENTRAL TEXAS COMMUNITY HEALTH CENTERS
Other - Org Name:COMMUNITYCARE--SAFE PLACE SHELTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:VLIET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-978-9050
Mailing Address - Street 1:15 WALLER ST
Mailing Address - Street 2:RBJ HEALTH CENTER
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-5240
Mailing Address - Country:US
Mailing Address - Phone:512-978-9074
Mailing Address - Fax:512-978-9013
Practice Address - Street 1:1401 GROVE BLVD
Practice Address - Street 2:SAFE PLACE SHELTER
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3458
Practice Address - Country:US
Practice Address - Phone:512-267-7233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
451973OtherMEDICARE A
TX451973Medicare Oscar/Certification
TX00HE66Medicare PIN