Provider Demographics
NPI:1992025761
Name:CHILDREN'S ADVOCACY CENTER OF BASTROP COUNTY
Entity Type:Organization
Organization Name:CHILDREN'S ADVOCACY CENTER OF BASTROP COUNTY
Other - Org Name:CHILDREN'S ADVOCACY CENTER OF BASTROP, LEE AND FAYETTE COUNTIES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-321-6161
Mailing Address - Street 1:1002 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3304
Mailing Address - Country:US
Mailing Address - Phone:512-321-6161
Mailing Address - Fax:512-303-3985
Practice Address - Street 1:1002 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3304
Practice Address - Country:US
Practice Address - Phone:512-321-6161
Practice Address - Fax:512-303-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable