DATE PREPARED: 01-09-21 H H S C REPORT NO.: HC062099 TIME PREPARED: 06:50 TXHML CDS AGENCY INFORMATION PAGE : 8 WAIVER CONTRACT AREA: 6 MRA: 030 AUSTIN TRAVIS INTEGRAL CARE ------------------------------------------------------------------------------ PROVIDER: 7E2 A FAMILY CHOICE CDS LLC CONTRACT NUMBER : 001024221 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 5 ------------------------------------------------------------------------------ PROVIDER: 7CW ACCOMMODATING HEALTHCARE SERVIES LLC CONTRACT NUMBER : 001024068 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: GUADALUPE 1 CONSUMERS ENROLLED STATEWIDE 34 ------------------------------------------------------------------------------ PROVIDER: 7GN ACUMEN FISCAL AGENT LLC CONTRACT NUMBER : 001030543 ACUMEN FISCAL AGENT LLC APPLICANT CONTACT: LEN DAVIS PHONE: (866) 759-3524 FAX: (855) 264-3287 PHYSICAL ADDRESS : 700 CENTRAL EXPRESSWAY S STE 400#18, ALLEN, TX 75013 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BURNET 1 FALLS 1 TRAVIS 2 WILLIAMSON 3 CONSUMERS ENROLLED STATEWIDE 148 ------------------------------------------------------------------------------ PROVIDER: 8WA ALAMO CONSUMER DIRECT LLC CONTRACT NUMBER : 001011365 CONSUMER DIRECT APPLICANT CONTACT: RAMONA SALOMONS PHONE: (877) 903-0832 FAX: (877) 652-0877 PHYSICAL ADDRESS : 8701 SHOAL CREEK BLVD SUITE 303, AUSTIN, TX 78757 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BASTROP 5 BELL 4 BURNET 3 CALDWELL 3 MILAM 2 TRAVIS 87 WILLIAMSON 65 CONSUMERS ENROLLED STATEWIDE 429 ------------------------------------------------------------------------------ PROVIDER: 7CR B & B NURSING AND OTHER HEALTH CONTRACT NUMBER : 001024009 B & B NURSING AND OTHER HEALTH APPLICANT CONTACT: BONSU AUGUSTINA PHONE: (281) 701-9191 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: 837 COMMUNITY ACCESS INC CONTRACT NUMBER : 001011020 COMMUNITY ACCESS II APPLICANT CONTACT: LAURA REDMAN PHONE: (903) 595-5644 FAX: (903) 526-0881 PHYSICAL ADDRESS : 2040 SHILOH RD, TYLER, TX 75703 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: WILLIAMSON 3 CONSUMERS ENROLLED STATEWIDE 208 ------------------------------------------------------------------------------ PROVIDER: 8TE CONSUMER DIRECTED SERVICES IN TEXAS, INC. CONTRACT NUMBER : 001011209 CDS IN TEXAS APPLICANT CONTACT: HELEN BAKER PHONE: (210) 798-3779 FAX: (210) 798-3779 DATE PREPARED: 01-09-21 H H S C REPORT NO.: HC062099 TIME PREPARED: 06:50 TXHML CDS AGENCY INFORMATION PAGE : 9 WAIVER CONTRACT AREA: 6 MRA: 030 AUSTIN TRAVIS INTEGRAL CARE PHYSICAL ADDRESS : 6243 IH-10 WEST SUITE 430, SAN ANTONIO, TX 78201 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BELL 16 BRAZOS 3 BURNET 2 FALLS 1 GUADALUPE 2 HILL 2 LAMPASAS 1 MCLENNAN 5 MILAM 1 TRAVIS 16 WILLIAMSON 21 CONSUMERS ENROLLED STATEWIDE 632 ------------------------------------------------------------------------------ PROVIDER: 7FZ CREATIVE IMPACT LLC CONTRACT NUMBER : 001029881 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: BELL 1 CONSUMERS ENROLLED STATEWIDE 1 ------------------------------------------------------------------------------ PROVIDER: 7BP FMSA HEALTHCARE SERVICES OF TE CONTRACT NUMBER : 001023955 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: 8PN GEOFFREY NZEADIBE CONTRACT NUMBER : 001010726 LUCKY ENTERPRISE APPLICANT CONTACT: GEOFFREY NZEADIBE PHONE: (972) 303-2800 FAX: (469) 442-0647 PHYSICAL ADDRESS : 3960 BROADWAY BLVD. SUITE 250, GARLAND, TX 75014 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 55 ------------------------------------------------------------------------------ PROVIDER: 8RQ HANDICAPPED RESOURCE ASSOCIATION CONTRACT NUMBER : 001010818 HELPING RESTORE ABILITY APPLICANT CONTACT: VICKI NIEDERMAYER PHONE: (817) 469-1977 FAX: (817) 461-2334 PHYSICAL ADDRESS : 4300 BELTWAY PLACE, #130, ARLINGTON, TX 76018 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: TRAVIS 1 CONSUMERS ENROLLED STATEWIDE 153 ------------------------------------------------------------------------------ PROVIDER: 8PT HEART OF CENTRAL TEXAS INDEPENDENT LIVING CENTER, INC.HOCTIL CONTRACT NUMBER : 001010651 HEART OF CENTRAL TEXAS INDEPENDENT APPLICANT CONTACT: PEGGY COSNER PHONE: (254) 933-7487 FAX: PHYSICAL ADDRESS : 222 EAST CENTRAL AVENUE, BELTON, TX 76513 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BELL 21 CORYELL 1 LAMPASAS 1 TRAVIS 1 CONSUMERS ENROLLED STATEWIDE 45 ------------------------------------------------------------------------------ PROVIDER: 8PV IMAGINE ENTERPRISE, INC CONTRACT NUMBER : 001010738 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 20 BRAZOS 1 CALDWELL 1 FAYETTE 1 MCLENNAN 1 WILLIAMSON 1 DATE PREPARED: 01-09-21 H H S C REPORT NO.: HC062099 TIME PREPARED: 06:50 TXHML CDS AGENCY INFORMATION PAGE : 10 WAIVER CONTRACT AREA: 6 MRA: 030 AUSTIN TRAVIS INTEGRAL CARE CONSUMERS ENROLLED STATEWIDE 305 ------------------------------------------------------------------------------ PROVIDER: 8PP OUTREACH HEALTH COMMUNITY CARE CONTRACT NUMBER : 001011557 OUTREACH HOME CARE APPLICANT CONTACT: STEPHEN ABSHIER PHONE: (512) 692-7810 FAX: (512) 973-8005 PHYSICAL ADDRESS : 269 WEST RENNER PKWY., RICHARDSON, TX 75080 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: WILLIAMSON 1 CONSUMERS ENROLLED STATEWIDE 16 ------------------------------------------------------------------------------ PROVIDER: 7GU PHOEBE ACOSTA RUIZ CONTRACT NUMBER : 001030714 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 2 ------------------------------------------------------------------------------ PROVIDER: 7GW RYSON FINANCIAL CORPORATION CONTRACT NUMBER : 001030733 RYSON FINANCIAL CORPORATION APPLICANT CONTACT: SUNDAY NWOSUOCHA PHONE: (832) 875-1802 FAX: (281) 201-8530 PHYSICAL ADDRESS : 4843 SUNSHINE DR, SUGARLAND, TX 77479 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 2 ------------------------------------------------------------------------------ PROVIDER: 8PR SEGNIK GROUP INC CONTRACT NUMBER : 001010670 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: FREESTONE 1 MCLENNAN 1 TRAVIS 8 WILLIAMSON 5 CONSUMERS ENROLLED STATEWIDE 339 ------------------------------------------------------------------------------ PROVIDER: 7BL SOLUTIONS FINANCIAL MANAGEMENT SERVICES, LLC CONTRACT NUMBER : 001023939 SOLUTIONS FINANCIAL MANAGEMENT SERV APPLICANT CONTACT: ROBERTSON LAWANDA PHONE: (903) 288-4948 FAX: (972) 426-7399 PHYSICAL ADDRESS : 718 WEST MAIN STREET, GUN BARREL CITY, TX 75156 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: FREESTONE 1 LIMESTONE 2 CONSUMERS ENROLLED STATEWIDE 27 ------------------------------------------------------------------------------ PROVIDER: 7CX TAB INTERNATIONAL INC CONTRACT NUMBER : 001024108 MEGAMED HEALTHCARE SERVICES APPLICANT CONTACT: BALOGUN 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 ------------------------------------------------------------------------------ PROVIDER: 7HL TIFFANY DRAKE CONTRACT NUMBER : 001031306 TIFFANY DRAKE DATE PREPARED: 01-09-21 H H S C REPORT NO.: HC062099 TIME PREPARED: 06:50 TXHML CDS AGENCY INFORMATION PAGE : 11 WAIVER CONTRACT AREA: 6 MRA: 030 AUSTIN TRAVIS INTEGRAL CARE APPLICANT CONTACT: DRAKE TIFFANY PHONE: (903) 624-4529 FAX: (000) 000-0000 PHYSICAL ADDRESS : 644 PEARCE DR, POTTSBORO, TX 75076-6988 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 0 ------------------------------------------------------------------------------ PROVIDER: 7HM WMAC GROUP LLC CONTRACT NUMBER : 001031455 WMAC GROUP LLC APPLICANT CONTACT: JAMES WEAKELY PHONE: (903) 563-4296 FAX: (000) 000-0000 PHYSICAL ADDRESS : 285 CR NE 2050, MOUNT VERNON, TX 75457 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: NONE CONSUMERS ENROLLED STATEWIDE 0 TOTAL NUMBER OF CONTRACTS THIS MRA: 21