NPIMap

Organization Active NPI

Houston Area Community Services, Inc.

Doing business as Avenue 360 Health and Wellness

  • Federally Qualified Health Center (FQHC)
  • Humble, TX
National Provider Identifier
1154817450
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HOUSTON AREA COMMUNITY SERVICES, INC.
Doing business as
Avenue 360 Health and Wellness
Practice address
18842 S Memorial Dr Ste 120
Humble, TX 77338-4229
Phone
(281) 570-2525
Fax
(832) 644-9596
NPI assigned
Jul 10, 2018
Last updated
Oct 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tequila Henderson
Title
Revenue Cycle Director
Phone
(713) 426-0027

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

18842 S Memorial Dr Ste 120
Humble, TX 77338-4229

Mailing address

2150 W. 18TH Street
Suite 300
Houston, TX 77008
Phone (713) 426-0027

Other names 1

  • Avenue 360 Health and Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071115000320 TX Part B Supplier - Clinic/Group Practice 6608977095 Receives reassigned benefits from 41 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Humble, TX; Houston, TX
O20190207002540 TX Part A Provider - Federally Qualified Health Center (FQHC) 6608977095 Practice locations: Humble, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154817450. Details of each certification follow.

Federally qualified health center certification: CCN 451048

Legal name
HOUSTON AREA COMMUNITY SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 6, 2019
Last certification
Feb 6, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 9, 1997 in TX
Enrollment address
18842 S Memorial Dr
Ste 206
Humble, TX 77338-4229

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Avenue 360 Health Wellness Pharmacy - Midtown7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tequila Henderson Individual Corporate Officer Sep 1, 2023
Corporate Director Sep 1, 2023
Operational/Managerial Control Sep 1, 2023

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Avenue 360 Health and WellnessHouston, TX, CCN 671910 Federally qualified health center Other Sep 1, 2023
Avenue 360 Health and Wellness - Spring CypressHouston, TX, CCN 741872 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2014
Avenue 360 Health and Wellness MidtownHouston, TX, CCN 451159 Federally qualified health center Operational/Managerial Control Mar 1, 2021

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1154817450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2150 W. 18TH STREET",
            "address_2": "SUITE 300",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77008",
            "telephone_number": "713-426-0027",
            "fax_number": "832-209-7186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18842 S MEMORIAL DR STE 120",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773384229",
            "telephone_number": "281-570-2525",
            "fax_number": "832-644-9596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOUSTON AREA COMMUNITY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-10",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "TEQUILA",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "713-426-0027"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avenue 360 Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Humble, TX

Sources for this page

Verify at the official NPI Registry.