Provider Demographics
NPI:1952678849
Name:COMMUNITY COUNCIL OF SOUTHWEST TEXAS, INC.
Entity Type:Organization
Organization Name:COMMUNITY COUNCIL OF SOUTHWEST TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-278-6268
Mailing Address - Street 1:PO BOX 1709
Mailing Address - Street 2:713 EAST MAIN STREET
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78802-1709
Mailing Address - Country:US
Mailing Address - Phone:830-278-6268
Mailing Address - Fax:830-278-4281
Practice Address - Street 1:713 E MAIN ST
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-5718
Practice Address - Country:US
Practice Address - Phone:830-278-6268
Practice Address - Fax:830-486-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)