Healthcare Provider Details

I. General information

NPI: 1306925102
Provider Name (Legal Business Name): SOUTHERN HEALTH CORP OF HOUSTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 E MADISON ST
HOUSTON MS
38851-2428
US

IV. Provider business mailing address

1002 E MADISON ST
HOUSTON MS
38851-2428
US

V. Phone/Fax

Practice location:
  • Phone: 662-456-3700
  • Fax: 662-456-1159
Mailing address:
  • Phone: 662-456-3700
  • Fax: 662-456-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: SHEILA BROCKMAN
Title or Position: CEO
Credential:
Phone: 662-456-3700