Provider Demographics
NPI:1235141409
Name:SPRING BRANCH COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:SPRING BRANCH COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-462-6565
Mailing Address - Street 1:5502 1ST ST
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2472
Mailing Address - Country:US
Mailing Address - Phone:713-462-6565
Mailing Address - Fax:832-831-5369
Practice Address - Street 1:1615 HLLLENDAHL BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3402
Practice Address - Country:US
Practice Address - Phone:713-462-6565
Practice Address - Fax:713-462-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165254702Medicaid
TX165254702Medicaid