{
"Npi": {
"NPI": "1912056730",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "BRAZOS VALLEY COMMUNITY ACTION AGENCY INC",
"ParentOrgTIN": null,
"OrgName": "BRAZOS VALLEY COMMUNITY ACTION AGENCY INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3400 S TEXAS AVE",
"SecondLineMailingAddress": "BLDG A SUITE 300",
"MailingAddressCityName": "BRYAN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77802-3148",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "979-977-6384",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3400 S TEXAS AVE",
"SecondLinePracticeLocationAddress": "BLDG. A SUITE 300",
"PracticeLocationAddressCityName": "BRYAN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77802-3148",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "979-595-1755",
"PracticeLocationAddressFaxNumber": "979-810-8151",
"EnumerationDate": "01/10/2007",
"LastUpdateDate": "08/07/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SABELLA",
"AuthorizedOfficialFirstName": "THERESA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "979-383-2348",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "16909",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}