MEDICARE: ANESSA COMMUNITY SERVICE

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1649473356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESSA COMMUNITY SERVICE

Provider Business Mailing Address
First Line	:	1610 BLODGETT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5017
Country	:	US
Telephone Number	:	713-668-9595
Fax Number	:	713-668-9590

Provider Business Practice Location Address
First Line	:	1610 BLODGETT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5017
Country	:	US
Telephone Number	:	713-668-9595
Fax Number	:	713-668-9590

Authorized Official
Title or Position	:	OWNER
Name	:	MS. VANESSA GREENRIDGE EMAMI
Credential	:
Telephone Number	:	713-668-9595

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	06/24/2008

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Directions to “ANESSA COMMUNITY SERVICE ” Practice Location

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