Provider Demographics
NPI:1689753485
Name:SOUTHERN HEALTH CORP OF HOUSTON INC
Entity Type:Organization
Organization Name:SOUTHERN HEALTH CORP OF HOUSTON INC
Other - Org Name:TRACE REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-456-3700
Mailing Address - Street 1:1002 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-2428
Mailing Address - Country:US
Mailing Address - Phone:662-456-3701
Mailing Address - Fax:662-456-1083
Practice Address - Street 1:1002 E MADISON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-2428
Practice Address - Country:US
Practice Address - Phone:662-456-3700
Practice Address - Fax:662-456-1159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN HEALTH CORP OF HOUSTON INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25S017Medicare Oscar/Certification
MS25S017Medicare ID - Type UnspecifiedGERO PSYCH