Healthcare Provider Details

I. General information

NPI: 1750470084
Provider Name (Legal Business Name): BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 S MAY ST
MADISONVILLE TX
77864-2564
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 936-348-3418
  • Fax: 936-349-0656
Mailing address:
  • Phone: 979-846-1100
  • Fax: 979-260-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: THERESA SABELLA
Title or Position: CEO
Credential: JD, PHD
Phone: 979-383-2348