Provider Demographics
NPI:1184344657
Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Entity type:Organization
Organization Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:JD, PHD
Authorized Official - Phone:979-383-2348
Mailing Address - Street 1:1500 UNIVERSITY DR E STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:317 N OWENSVILLE STREET
Practice Address - Street 2:RM #MC1
Practice Address - City:FRANKLIN
Practice Address - State:TX
Practice Address - Zip Code:77856
Practice Address - Country:US
Practice Address - Phone:979-977-5640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)