Provider Demographics
NPI:1861117517
Name:SSA VENTURES, LLC
Entity type:Organization
Organization Name:SSA VENTURES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HONAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-271-4240
Mailing Address - Street 1:1714 CHARLESTOWN NEW ALBANY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-9708
Mailing Address - Country:US
Mailing Address - Phone:812-271-4240
Mailing Address - Fax:
Practice Address - Street 1:1714 CHARLESTOWN NEW ALBANY RD STE 100
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-9708
Practice Address - Country:US
Practice Address - Phone:812-271-4240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care