Basic Information
| Provider Information | |||||||||
| NPI: | 1417036534 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTH CENTRAL HOUSTON ACTION COUNCIL, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CENTRAL CARE COMMUNITY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 300345 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772300345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137344580 | ||||||||
| FaxNumber: | 7137341564 | ||||||||
| Practice Location | |||||||||
| Address1: | 8610 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770332308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137340199 | ||||||||
| FaxNumber: | 7137341564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 11/24/2010 | ||||||||
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| AuthorizedOfficialLastName: | ROLAND | ||||||||
| AuthorizedOfficialFirstName: | MARCUS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 7137344580 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 111687302 | 05 | TX | MEDICAID |