1780777318 NPI number — BRENHAM OUTREACH ADVISORY COUNCIL, INC.

Table of content: (NPI 1780777318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780777318 NPI number — BRENHAM OUTREACH ADVISORY COUNCIL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRENHAM OUTREACH ADVISORY COUNCIL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRENHAM OPPORTUNITY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780777318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 RINK ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENHAM
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77833-2624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-836-9370
Provider Business Mailing Address Fax Number:
979-836-7608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 RINK ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRENHAM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77833-2624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-836-9370
Provider Business Practice Location Address Fax Number:
979-836-7608
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
SHELLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
979-836-9370

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251B00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251C00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251C00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com