DATE PREPARED: 05-30-20 H H S C REPORT NO.: HC062098 TIME PREPARED: 06:15 HCS CDS AGENCY INFORMATION PAGE : 7 WAIVER CONTRACT AREA: 6 MRA: 030 AUSTIN TRAVIS INTEGRAL CARE ------------------------------------------------------------------------------ PROVIDER: 7E2 A FAMILY CHOICE CDS LLC CONTRACT NUMBER : 001022133 A FAMILY CHOICE CDS LLC APPLICANT CONTACT: CYNTHIA SMITH PHONE: (678) 674-9996 FAX: (214) 723-7016 PHYSICAL ADDRESS : 7104 MIDDLEBURG DR, PLANO, TX 75074 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 1 ------------------------------------------------------------------------------ PROVIDER: 7CW ACCOMMODATING HEALTHCARE SERVIES LLC CONTRACT NUMBER : 001021954 ACCOMMODATING HEALTHCARE SERVIES LL APPLICANT CONTACT: CALANDRA ROLLINS PHONE: (817) 339-6733 FAX: (682) 651-4126 PHYSICAL ADDRESS : 2706 SE LOOP 820, FORT WORTH, TX 76140 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 26 ------------------------------------------------------------------------------ PROVIDER: 7GN ACUMEN FISCAL AGENT LLC CONTRACT NUMBER : 001030558 ACUMEN FISCAL AGENT LLC APPLICANT CONTACT: LEN DAVIS PHONE: (866) 759-9524 FAX: (855) 264-3287 PHYSICAL ADDRESS : 700 CENTRAL EXPRESSWAY S STE 400#18, ALLEN, TX 75013 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BRAZOS 2 BURNET 1 CONSUMERS ENROLLED STATEWIDE 11 ------------------------------------------------------------------------------ PROVIDER: 8WA ALAMO CONSUMER DIRECT LLC CONTRACT NUMBER : 001009084 CONSUMER DIRECT APPLICANT CONTACT: RAMONA SALOMONS PHONE: (877) 903-0832 FAX: (877) 652-0877 PHYSICAL ADDRESS : 8701 SHOAL CREEK BLVD, AUSTIN, TX 78757 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BELL 2 TRAVIS 36 WILLIAMSON 28 CONSUMERS ENROLLED STATEWIDE 447 ------------------------------------------------------------------------------ PROVIDER: 7CR B & B NURSING AND OTHER HEALTH CONTRACT NUMBER : 001021885 B & B NURSING AND OTHER HEALTH APPLICANT CONTACT: BONSU AUGUSTINA PHONE: (281) 701-9797 FAX: (972) 707-0587 PHYSICAL ADDRESS : 4040 SPRING VALLEY ROAD #103C, FARMERS BRANCH, TX 75244 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 0 ------------------------------------------------------------------------------ PROVIDER: 79L BWC HEALTHCARE,LLC CONTRACT NUMBER : 001021482 BWC HEALTHCARE SERVICES APPLICANT CONTACT: ROY COWARD PHONE: (281) 494-6363 FAX: (877) 935-4823 PHYSICAL ADDRESS : 4311 APRIL MEADOW WAY, SUGAR LAND, TX 77479 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BASTROP 1 BRAZOS 2 FALLS 1 MCLENNAN 2 CONSUMERS ENROLLED STATEWIDE 122 ------------------------------------------------------------------------------ PROVIDER: 837 COMMUNITY ACCESS INC CONTRACT NUMBER : 001009044 COMMUNITY ACCESS II APPLICANT CONTACT: LAURA REDMAN PHONE: (903) 595-5644 FAX: (903) 526-0881 PHYSICAL ADDRESS : 2040 SHILOH RD, TYLER, TX 75703 DATE PREPARED: 05-30-20 H H S C REPORT NO.: HC062098 TIME PREPARED: 06:15 HCS CDS AGENCY INFORMATION PAGE : 8 WAIVER CONTRACT AREA: 6 MRA: 030 AUSTIN TRAVIS INTEGRAL CARE CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: WILLIAMSON 2 CONSUMERS ENROLLED STATEWIDE 468 ------------------------------------------------------------------------------ PROVIDER: 8TE CONSUMER DIRECTED SERVICES IN TEXAS, INC. CONTRACT NUMBER : 001008729 CDS IN TEXAS APPLICANT CONTACT: HELEN M. BAKER PHONE: (210) 798-3779 FAX: (210) 798-3779 PHYSICAL ADDRESS : 6243 IH 10 WEST, STE. 375, SAN ANTONIO, TX 78201 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BASTROP 1 BELL 3 BRAZOS 5 GRIMES 1 GUADALUPE 4 HILL 1 LIMESTONE 1 MCLENNAN 5 TRAVIS 34 WILLIAMSON 11 CONSUMERS ENROLLED STATEWIDE 612 ------------------------------------------------------------------------------ PROVIDER: 7FZ CREATIVE IMPACT LLC CONTRACT NUMBER : 001029880 CREATIVE IMPACT LLC APPLICANT CONTACT: JONES QUINTINA PHONE: (713) 320-1329 FAX: (000) 000-0000 PHYSICAL ADDRESS : 11403 FAWNWAY DR, HOUSTON, TX 77048 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 1 ------------------------------------------------------------------------------ PROVIDER: 812 DISABILITY SERVICES OF THE SOUTHWEST, INC. CONTRACT NUMBER : 001008507 DISABILITY SERVICES OF THE SOUTHWES APPLICANT CONTACT: LYNNE BROOKS PHONE: (866) 675-7331 FAX: (210) 785-6717 PHYSICAL ADDRESS : 6243 IH-10 WEST SUITE 375, SAN ANTONIO, TX 78201 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 4 ------------------------------------------------------------------------------ PROVIDER: 7BP FMSA HEALTHCARE SERVICES OF TE CONTRACT NUMBER : 001021733 FMSA HEALTHCARE SERVICES OF TEXAS I APPLICANT CONTACT: OBASANYA ADEBUKOLA PHONE: (214) 351-3360 FAX: (214) 988-1488 PHYSICAL ADDRESS : 2516 SHADY GROVE LANE, MCKINNEY, TX 75071 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 0 ------------------------------------------------------------------------------ PROVIDER: 8PT HEART OF CENTRAL TEXAS INDEPENDENT LIVING CENTER, INC.HOCTIL CONTRACT NUMBER : 001008197 HEART OF CENTRAL TEXAS INDEPENDENT APPLICANT CONTACT: PEGGY COSNER PHONE: (254) 770-2350 FAX: PHYSICAL ADDRESS : 222 EAST CENTRAL AVENUE, BELTON, TX 76513 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BELL 15 TRAVIS 1 CONSUMERS ENROLLED STATEWIDE 45 ------------------------------------------------------------------------------ PROVIDER: 8PV IMAGINE ENTERPRISE, INC CONTRACT NUMBER : 001008317 IMAGINE ENTERPRISE, INC. APPLICANT CONTACT: NORINE JALOWAY PHONE: (800) 572-7159 FAX: (832) 563-0661 PHYSICAL ADDRESS : 1402 SPRING CRESS LANE, SEABROOK, TX 77586 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BASTROP 3 BELL 2 BURNET 1 FAYETTE 1 GONZALES 1 GUADALUPE 1 MCLENNAN 2 ROBERTSON 1 TRAVIS 10 WILLIAMSON 11 CONSUMERS ENROLLED STATEWIDE 285 DATE PREPARED: 05-30-20 H H S C REPORT NO.: HC062098 TIME PREPARED: 06:15 HCS CDS AGENCY INFORMATION PAGE : 9 WAIVER CONTRACT AREA: 6 MRA: 030 AUSTIN TRAVIS INTEGRAL CARE ------------------------------------------------------------------------------ PROVIDER: 8PS IN-HOME ATTENDANT SERVICES LTD CONTRACT NUMBER : 001008304 IN-HOME ATTENDANT SERVICES LTD APPLICANT CONTACT: PATSY WH. LEGE PHONE: (713) 528-6499 FAX: PHYSICAL ADDRESS : 3333 FANNIN STE 109, HOUSTON, TX 77219-1245 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BELL 4 BRAZOS 7 TRAVIS 8 WILLIAMSON 1 CONSUMERS ENROLLED STATEWIDE 49 ------------------------------------------------------------------------------ PROVIDER: 77W OLAWUMI O OLADEJI CONTRACT NUMBER : 001009879 GLORY FINANCIAL SERVICES APPLICANT CONTACT: OLAWUMI OLADEJI PHONE: (469) 765-2873 FAX: (469) 375-3983 PHYSICAL ADDRESS : 423 W. WHEATLAND RD, SUITE 102, DUNCANVILLE, TX 75116 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: WILLIAMSON 1 CONSUMERS ENROLLED STATEWIDE 3 ------------------------------------------------------------------------------ PROVIDER: 8PP OUTREACH HEALTH COMMUNITY CARE CONTRACT NUMBER : 001008203 OUTREACH HOME CARE APPLICANT CONTACT: STEPHEN ABSHIER PHONE: (512) 692-7810 FAX: (512) 973-8005 PHYSICAL ADDRESS : 269 WEST REMMER PKWY., RICHARDSON, TX 75080 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: TRAVIS 14 CONSUMERS ENROLLED STATEWIDE 59 ------------------------------------------------------------------------------ PROVIDER: 7GU PHOEBE ACOSTA RUIZ CONTRACT NUMBER : 001030695 PHOEBE ACOSTA RUIZ APPLICANT CONTACT: PHOEBE RUIZ PHONE: (713) 885-2667 FAX: (281) 661-1666 PHYSICAL ADDRESS : 15434 W WILLOWWIND CIR, HOUSTON, TX 77071 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 1 ------------------------------------------------------------------------------ PROVIDER: 7GW RYSON FINANCIAL CORPORATION CONTRACT NUMBER : 001030776 RYSON FINANCIAL CORPORATION APPLICANT CONTACT: NWOSUOCHA SUNDAY PHONE: (832) 875-1802 FAX: (281) 201-1802 PHYSICAL ADDRESS : 4843 SUNSHINE DRIVE, SUGAR LAND, TX 77479 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 0 ------------------------------------------------------------------------------ PROVIDER: 8PR SEGNIK GROUP INC CONTRACT NUMBER : 001008217 SEGNIK GROUP INC APPLICANT CONTACT: JOSHUA OYENIYI PHONE: (713) 484-8699 FAX: (713) 484-8675 PHYSICAL ADDRESS : 7001 CORPORATE DRIVE #215, HOUSTON, TX 77036 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BELL 1 FREESTONE 2 HAMILTON 1 MCLENNAN 3 TRAVIS 5 WILLIAMSON 5 CONSUMERS ENROLLED STATEWIDE 325 ------------------------------------------------------------------------------ PROVIDER: 7CX TAB INTERNATIONAL INC CONTRACT NUMBER : 001022005 MEGAMED HEALTHCARE SERVICE DATE PREPARED: 05-30-20 H H S C REPORT NO.: HC062098 TIME PREPARED: 06:15 HCS CDS AGENCY INFORMATION PAGE : 10 WAIVER CONTRACT AREA: 6 MRA: 030 AUSTIN TRAVIS INTEGRAL CARE APPLICANT CONTACT: BALOGUIN ABAYOMI PHONE: (713) 772-2726 FAX: (000) 000-0000 PHYSICAL ADDRESS : 10101 FONDREN ROAD SUITE 428, HOUSTON, TX 77096 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 0 TOTAL NUMBER OF CONTRACTS THIS MRA: 20