MEDICARE: LONE STAR DEVELOPMENTAL 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1811795974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR DEVELOPMENTAL SERVICES LLC

Provider Business Mailing Address
First Line	:	7103 MOHAVE HLS
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-1127
Country	:	US
Telephone Number	:	346-606-6201
Fax Number	:

Provider Business Practice Location Address
First Line	:	7103 MOHAVE HLS
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-1127
Country	:	US
Telephone Number	:	346-606-6201
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	PATRICIA BREAZIEL
Credential	:
Telephone Number	:	346-606-6201

Provider Enumeration Date	:	03/05/2025
Last Update Date	:	03/05/2025

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