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	300249AP	CA

General Provider Information

NPI Number	:	1568705317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY HOUSING SERVICES INC.

Provider Business Mailing Address
First Line	:	17602 17TH ST STE 102-123
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-1961
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 DORMAN ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-2523
Country	:	US
Telephone Number	:	714-486-3691
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MAY ABDELNABY
Credential	:
Telephone Number	:	714-883-3133

Provider Enumeration Date	:	03/30/2013
Last Update Date	:	03/30/2013

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