Provider Demographics
NPI:1821177866
Name:SOUTH CENTRAL HOUSTON ACTION COUNCIL, INC.
Entity Type:Organization
Organization Name:SOUTH CENTRAL HOUSTON ACTION COUNCIL, INC.
Other - Org Name:CENTRAL CARE COMMUNITY HEALTH CENTER - RIVERSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-734-4580
Mailing Address - Street 1:P.O. BOX 300345
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-0345
Mailing Address - Country:US
Mailing Address - Phone:713-734-4580
Mailing Address - Fax:713-734-1564
Practice Address - Street 1:3315 DELANO STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-3284
Practice Address - Country:US
Practice Address - Phone:713-831-9663
Practice Address - Fax:713-831-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111687304Medicaid
TX67-1811Medicare UPIN