Provider Demographics
NPI:1023294840
Name:ELLA AUSTIN COMMUNITY CENTER
Entity type:Organization
Organization Name:ELLA AUSTIN COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HARGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-224-2351
Mailing Address - Street 1:PO BOX 8147
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78208-0147
Mailing Address - Country:US
Mailing Address - Phone:210-224-2351
Mailing Address - Fax:210-229-9126
Practice Address - Street 1:1023 N PINE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78202-1203
Practice Address - Country:US
Practice Address - Phone:210-224-2351
Practice Address - Fax:210-229-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121190261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care