Basic Information
| Provider Information | |||||||||
| NPI: | 1467517508 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CLASS PROGRAM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 610 | ||||||||
| Address2: | 411 AUSTIN STREET | ||||||||
| City: | LEVELLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793360610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068946104 | ||||||||
| FaxNumber: | 8068970835 | ||||||||
| Practice Location | |||||||||
| Address1: | 3513 50TH ST STE A | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794134015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067976393 | ||||||||
| FaxNumber: | 8067976397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | POWELL | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8068946104 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 000750 | TX | Y | Agencies | Home Health |
No ID Information.