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General NPI Number Information
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NPI Number | 1821185299
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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 | 10/06/2006
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Last Update Date | 02/19/2025
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Provider Practice Location 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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Provider Business Mailing Address
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Address Line | 1500 UNIVERSITY DR E
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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 | 979-810-8148
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Fax | 979-260-9390
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | AMANDA KIRKLAND
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Credential |
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Telephone | 979-596-5852
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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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