Provider Demographics
NPI:1952683641
Name:LONE STAR HOME HEALTH
Entity Type:Organization
Organization Name:LONE STAR HOME HEALTH
Other - Org Name:LONE STAR HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:956-203-3212
Mailing Address - Street 1:1409 TESORO AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO VIEJO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9710
Mailing Address - Country:US
Mailing Address - Phone:956-203-3212
Mailing Address - Fax:956-550-8999
Practice Address - Street 1:1409 TESORO AVE
Practice Address - Street 2:
Practice Address - City:RANCHO VIEJO
Practice Address - State:TX
Practice Address - Zip Code:78575-9710
Practice Address - Country:US
Practice Address - Phone:956-203-3212
Practice Address - Fax:956-550-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014526251E00000X
251J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2888182-01Medicaid
TX288182-02Medicaid