=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104154962
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONESTAR ELDER CARE,LCC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2009
-----------------------------------------------------
Last Update Date | 12/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16511 SPERRY GARDENS DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77095-5552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-588-3243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16511 SPERRY GARDENS DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77095-5552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-588-3243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEFF FINANCIAL OFFICER
-----------------------------------------------------
Name | MRS. MARY LUANA HART
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-588-3243
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------