Provider Demographics
NPI:1871035865
Name:LONE STAR PROVIDER CARE LLC
Entity Type:Organization
Organization Name:LONE STAR PROVIDER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MONZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-616-2230
Mailing Address - Street 1:5309 WURZBACH RD. STE 200-1
Mailing Address - Street 2:
Mailing Address - City:LEON VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78238
Mailing Address - Country:US
Mailing Address - Phone:210-616-2230
Mailing Address - Fax:210-568-4503
Practice Address - Street 1:5309 WURZBACH RD STE 200-1
Practice Address - Street 2:
Practice Address - City:LEON VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78238-2444
Practice Address - Country:US
Practice Address - Phone:210-852-1664
Practice Address - Fax:210-465-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0178753747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty