Provider Demographics
NPI:1184096273
Name:SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
Entity type:Organization
Organization Name:SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-762-2447
Mailing Address - Street 1:PO BOX 2435
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:TX
Mailing Address - Zip Code:76430-8020
Mailing Address - Country:US
Mailing Address - Phone:325-762-2447
Mailing Address - Fax:
Practice Address - Street 1:217 EDWARDS
Practice Address - Street 2:
Practice Address - City:MERKEL
Practice Address - State:TX
Practice Address - Zip Code:79536-3803
Practice Address - Country:US
Practice Address - Phone:325-928-0014
Practice Address - Fax:325-925-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)