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General NPI Number Information
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NPI Number | 1609363696
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Entity Type | Organization
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Legal Business Name | SOUTHERN AREA HIV-AIDS AWARENESS EDUCATION AND PREVENTION CENTER
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1424 COPPER MEADOW DR
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City | MESQUITE
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State | TX
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Zip | 75149-6879
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Country | US
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Telephone | 972-740-7445
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Fax |
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Provider Business Mailing Address
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Address Line | 1424 COPPER MEADOW DR # A
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City | MESQUITE
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State | TX
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Zip | 75149-6879
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Country | US
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Telephone | 972-740-7445
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. RICK J DAVIS
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Credential | PH.D
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Telephone | 972-740-7445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | TX
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