MEDICARE: NOSSTOD

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1881858116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOSSTOD

Provider Business Mailing Address
First Line	:	3110 EBBTIDE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-4508
Country	:	US
Telephone Number	:	713-434-5007
Fax Number	:

Provider Business Practice Location Address
First Line	:	5411 LYNDHURST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-2911
Country	:	US
Telephone Number	:	281-773-1842
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. SAMUEL DOTSON
Credential	:
Telephone Number	:	713-434-5007

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	07/16/2008

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Directions to “NOSSTOD ” Practice Location

Language	Start Address	Practice Location

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