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General NPI Number Information
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NPI Number | 1811171580
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Entity Type | Organization
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Legal Business Name | BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 1602 ROCK PRAIRIE RD STE 300
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City | COLLEGE STATION
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State | TX
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Zip | 77845-8309
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Country | US
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Telephone | 979-693-7400
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Fax | 979-693-7446
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Provider Business Mailing Address
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Address Line | 1500 UNIVERSITY DR E #100
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City | COLLEGE STATION
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State | TX
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Zip | 77840-2600
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Country | US
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Telephone | 979-846-1100
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Fax | 979-260-9390
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Authorized Official
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Title or Position | CEO
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Name | THERESA SABELLA
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Credential | JD, PHD
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Telephone | 979-383-2340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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