MEDICARE: CHILD WELFARE ALLIANCE OF CALHOUN COUNTY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1841439981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD WELFARE ALLIANCE OF CALHOUN COUNTY INC.

Provider Business Mailing Address
First Line	:	215 W RAILROAD ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-3332
Country	:	US
Telephone Number	:	361-552-1982
Fax Number	:	361-552-4309

Provider Business Practice Location Address
First Line	:	215 W RAILROAD ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-3332
Country	:	US
Telephone Number	:	361-552-1982
Fax Number	:	361-552-4309

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. VIRGINIA HAHN LOIS HAHN
Credential	:	R.N.
Telephone Number	:	361-552-1982

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	02/12/2009

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