MEDICARE: RUSSO AND ASSOCIATES

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		TX

General Provider Information

NPI Number	:	1376842021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSSO AND ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 55242
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77255-5242
Country	:	US
Telephone Number	:	832-286-7867
Fax Number	:

Provider Business Practice Location Address
First Line	:	5007 FM 1960 RD W
Second Line	:	#433
City	:	HOUSTON
State	:	TX
Zip	:	77069-4528
Country	:	US
Telephone Number	:	832-286-7867
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROGRAM MANAGER
Name	:	MRS. BRITTNEY RUSSO
Credential	:
Telephone Number	:	832-286-7867

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	03/21/2011

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