Provider Demographics
NPI:1700973187
Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Entity Type:Organization
Organization Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Other - Org Name:GRIMES COUNTY COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALS
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:V
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-846-1100
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:#100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:1905 DOVE CROSSING
Practice Address - Street 2:#C
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-3858
Practice Address - Country:US
Practice Address - Phone:936-825-0000
Practice Address - Fax:936-825-8001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAZOS VALLEY COMMUNITY ACTION AGENCY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000951607Medicaid
TX1821185299OtherNPI AGENCY
TX000951605Medicaid
TX451981Medicare Oscar/Certification