Basic Information
| Provider Information | |||||||||
| NPI: | 1154817450 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOUSTON AREA COMMUNITY SERVICES, INC. | ||||||||
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| OtherOrganizationName: | AVENUE 360 NORTHEAST | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 W. 18TH STREET | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134260027 | ||||||||
| FaxNumber: | 8322097186 | ||||||||
| Practice Location | |||||||||
| Address1: | 9816 MEMORIAL BLVD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | HUMBLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134260027 | ||||||||
| FaxNumber: | 8322097186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2018 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | PEER | ||||||||
| AuthorizedOfficialFirstName: | APRIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7134260027 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
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.