Basic Information
| Provider Information | |||||||||
| NPI: | 1518215060 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTH CENTRAL HOUSTON ACTION COUNCIL INC | ||||||||
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| OtherOrganizationName: | CENTRAL CARE COMMUNITY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8610 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770332308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137340199 | ||||||||
| FaxNumber: | 7137340286 | ||||||||
| Practice Location | |||||||||
| Address1: | 1102 PINEMONT DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770181300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137340199 | ||||||||
| FaxNumber: | 7137340286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2012 | ||||||||
| LastUpdateDate: | 08/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | ROLAND | ||||||||
| AuthorizedOfficialFirstName: | MARCUS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/ PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7137340199 | ||||||||
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| 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) |
No ID Information.