MEDICARE: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	385H00000X	Respite Care	TX
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251X00000X	Supports Brokerage Agency	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437215787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC.

Provider Business Mailing Address
First Line	:	PO BOX 610
Second Line	:	411 AUSTIN ST
City	:	LEVELLAND
State	:	TX
Zip	:	79336-0610
Country	:	US
Telephone Number	:	806-894-6104
Fax Number	:	806-897-0835

Provider Business Practice Location Address
First Line	:	411 AUSTIN ST
Second Line	:
City	:	LEVELLAND
State	:	TX
Zip	:	79336-4733
Country	:	US
Telephone Number	:	806-894-6104
Fax Number	:	806-897-0835

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. WILLIAM D POWELL JR.
Credential	:
Telephone Number	:	806-894-6104

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	01/05/2017

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