Provider Demographics
NPI:1538370762
Name:LONE STAR HCS, INC.
Entity type:Organization
Organization Name:LONE STAR HCS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-777-2028
Mailing Address - Street 1:PO BOX 1751
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-1751
Mailing Address - Country:US
Mailing Address - Phone:936-777-2028
Mailing Address - Fax:936-228-7641
Practice Address - Street 1:305 W MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-8678
Practice Address - Country:US
Practice Address - Phone:936-777-2028
Practice Address - Fax:936-756-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001029017OtherHCS PROVIDER
TX1538370762Medicaid
TX001007965OtherHCS PROVIDER