Healthcare Provider Details

I. General information

NPI: 1740385491
Provider Name (Legal Business Name): SOUTHERN HEALTH CORP OF HOUSTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EAST MADISON
HOUSTON MS
38851
US

IV. Provider business mailing address

1000 EAST MADISON
HOUSTON MS
38851
US

V. Phone/Fax

Practice location:
  • Phone: 662-456-1101
  • Fax: 662-456-1106
Mailing address:
  • Phone: 662-456-1101
  • Fax: 662-456-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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