Provider Demographics
NPI:1609363696
Name:SOUTHERN AREA HIV-AIDS AWARENESS EDUCATION AND PREVENTION CENTER
Entity Type:Organization
Organization Name:SOUTHERN AREA HIV-AIDS AWARENESS EDUCATION AND PREVENTION CENTER
Other - Org Name:ADULT BEHAVIORAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-740-7445
Mailing Address - Street 1:1424 COPPER MEADOW DR # A
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6879
Mailing Address - Country:US
Mailing Address - Phone:972-740-7445
Mailing Address - Fax:
Practice Address - Street 1:1424 COPPER MEADOW DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6879
Practice Address - Country:US
Practice Address - Phone:972-740-7445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN AREA HIV-AIDS AWARENESS EDUCATION AND PREVENTION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health