Healthcare Provider Details

I. General information

NPI: 1699831685
Provider Name (Legal Business Name): SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 HOUSTON ST
LEVELLAND TX
79336-4044
US

IV. Provider business mailing address

PO BOX 610
LEVELLAND TX
79336-0610
US

V. Phone/Fax

Practice location:
  • Phone: 806-894-7872
  • Fax: 806-894-1621
Mailing address:
  • Phone: 806-894-6104
  • Fax: 806-897-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: LISA J MADDOX
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 806-894-7872