Provider Demographics
NPI:1790382596
Name:SOUTHERN SECTOR HEALTH INITIATIVE
Entity Type:Organization
Organization Name:SOUTHERN SECTOR HEALTH INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/VP
Authorized Official - Prefix:
Authorized Official - First Name:VENITA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-865-3099
Mailing Address - Street 1:4500 SPRING AVE STE 142
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75210-1350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4500 SPRING AVE STE 142
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75210-1350
Practice Address - Country:US
Practice Address - Phone:214-865-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health