MEDICARE: HOUSTON COUNTY AGING 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	332U00000X	Home Delivered Meals

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S5170	OTHER	TX	HOME DELIVERED MEALS S5170

General Provider Information

NPI Number	:	1902206915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON COUNTY AGING SERVICE

Provider Business Mailing Address
First Line	:	112 E HOUSTON AVE
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-1949
Country	:	US
Telephone Number	:	936-544-3255
Fax Number	:	936-544-9291

Provider Business Practice Location Address
First Line	:	112 E HOUSTON AVE
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-1949
Country	:	US
Telephone Number	:	936-544-3255
Fax Number	:	936-544-9291

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ASHLEY ASHLEY
Credential	:
Telephone Number	:	936-544-3255

Provider Enumeration Date	:	08/27/2014
Last Update Date	:	08/27/2014

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Directions to “HOUSTON COUNTY AGING SERVICE ” Practice Location

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