Basic Information
Provider Information
NPI: 1932265451
EntityType: 2
ReplacementNPI:  
OrganizationName: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: COMMUNITY ACTION VFI
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 610
Address2: 411 AUSTIN ST
City: LEVELLAND
State: TX
PostalCode: 793360610
CountryCode: US
TelephoneNumber: 8068946104
FaxNumber: 8968978035
Practice Location
Address1: 411 AUSTIN ST
Address2:  
City: LEVELLAND
State: TX
PostalCode: 793364733
CountryCode: US
TelephoneNumber: 8068946104
FaxNumber: 8068970835
Other Information
ProviderEnumerationDate: 12/29/2006
LastUpdateDate: 12/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: POWELL
AuthorizedOfficialFirstName: WILLIAM
AuthorizedOfficialMiddleName: D
AuthorizedOfficialTitleorPosition: EXECUTIVE DIRECTOR
AuthorizedOfficialTelephone: 8068946104
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix: JR.
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
385H00000X TXN Respite Care FacilityRespite Care 
251X00000X TXY AgenciesSupports Brokerage 

ID Information
IDTypeStateIssuerDescription
00100355205TX MEDICAID


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