Healthcare Provider Details

I. General information

NPI: 1811171580
Provider Name (Legal Business Name): BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 ROCK PRAIRIE RD STE 300
COLLEGE STATION TX
77845-8309
US

IV. Provider business mailing address

1500 UNIVERSITY DR E #100
COLLEGE STATION TX
77840-2600
US

V. Phone/Fax

Practice location:
  • Phone: 979-693-7400
  • Fax: 979-693-7446
Mailing address:
  • Phone: 979-846-1100
  • Fax: 979-260-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA SABELLA
Title or Position: CEO
Credential: JD, PHD
Phone: 979-383-2340