Healthcare Provider Details

I. General information

NPI: 1609363696
Provider Name (Legal Business Name): SOUTHERN AREA HIV-AIDS AWARENESS EDUCATION AND PREVENTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 COPPER MEADOW DR
MESQUITE TX
75149-6879
US

IV. Provider business mailing address

1424 COPPER MEADOW DR # A
MESQUITE TX
75149-6879
US

V. Phone/Fax

Practice location:
  • Phone: 972-740-7445
  • Fax:
Mailing address:
  • Phone: 972-740-7445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. RICK J DAVIS
Title or Position: PRESIDENT & CEO
Credential: PH.D
Phone: 972-740-7445