MEDICARE: HOUSER COMMUNITY SUPPORT SERVICES, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710010913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSER COMMUNITY SUPPORT SERVICES, LLC

Provider Business Mailing Address
First Line	:	2905 LYNNWOOD DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2942
Country	:	US
Telephone Number	:	573-442-1740
Fax Number	:	573-442-1740

Provider Business Practice Location Address
First Line	:	2313 PRIMROSE DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-1214
Country	:	US
Telephone Number	:	573-447-4440
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. NORMAN HAROLD HOUSER
Credential	:	PSYCHOLOGIST
Telephone Number	:	573-442-1740

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	06/24/2008

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