MEDICARE: LIBERTY HOUSING SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1548851652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY HOUSING SERVICES INC.

Provider Business Mailing Address
First Line	:	17602 17TH ST # 102-123
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-1961
Country	:	US
Telephone Number	:	714-463-6572
Fax Number	:	714-591-0933

Provider Business Practice Location Address
First Line	:	4029 WESTERLY PL STE 101
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2329
Country	:	US
Telephone Number	:	714-875-5479
Fax Number	:	714-591-0933

Authorized Official
Title or Position	:	OWNER
Name	:	MAY ABDELNABY
Credential	:
Telephone Number	:	714-875-5479

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	10/24/2023

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