CONSUMERS ENROLLED STATEWIDE 92

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1 DATE PREPARED: D A D S REPORT NO.: HC TIME PREPARED: 03:37 HCS CDS AGENCY INFORMATION PAGE : 138 WAIVER CONTRACT AREA: 6 MRA: 460 BLUEBONNET TRAILS COMM. SVCS PROVIDER: 8CH ABILITY CONNECTION TEXAS CONTRACT NUMBER : ABILITY CONNECTION TEXAS APPLICANT CONTACT: REBECCA ADAMS PHONE: (214) FAX: (214) PHYSICAL ADDRESS : 8802 HARRY HINES BLVD, DALLAS, TX CONSUMERS ENROLLED STATEWIDE 317 PROVIDER: 8WA ALAMO CONSUMER DIRECT LLC CONTRACT NUMBER : ALAMO CONSUMER DIRECT LLC APPLICANT CONTACT: RAMONA SALOMONS PHONE: (877) FAX: (877) PHYSICAL ADDRESS : 8701 SHOAL CREEK BLVD, AUSTIN, TX CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: CALDWELL 1 MCLENNAN 1 TRAVIS 2 WILLIAMSON 1 CONSUMERS ENROLLED STATEWIDE 92 PROVIDER: 837 COMMUNITY ACCESS INC CONTRACT NUMBER : COMMUNITY ACCESS INC APPLICANT CONTACT: LAURA REDMAN PHONE: (903) FAX: (903) PHYSICAL ADDRESS : 2040 SHILOH RD, TYLER, TX CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: WILLIAMSON 1 CONSUMERS ENROLLED STATEWIDE 421 PROVIDER: 8TE CONSUMER DIRECTED SERVICES IN TEXAS, INC. CONTRACT NUMBER : CONSUMER DIRECTED SERVICES IN TEXAS, INC. APPLICANT CONTACT: HELEN M. BAKER PHONE: (210) FAX: (210) PHYSICAL ADDRESS : 6243 IH 10 WEST, STE. 375, SAN ANTONIO, TX CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BELL 3 BRAZOS 2 GUADALUPE 2 TRAVIS 9 CONSUMERS ENROLLED STATEWIDE 116 PROVIDER: 8W6 CROWNCARE MANAGEMENTS LLC CONTRACT NUMBER : CROWNCARE MANAGEMENTS, LLC APPLICANT CONTACT: BERNADETTE KEKE PHONE: (832) FAX: (281) PHYSICAL ADDRESS : 1123 DEEP RIVER DRIVE, RICHMOND, TX CONSUMERS ENROLLED STATEWIDE 1

2 PROVIDER: 812 DISABILITY SERVICES OF THE SOUTHWEST, INC. CONTRACT NUMBER : DISABILITY SERVICES OF THE SOUTHWEST,INC. APPLICANT CONTACT: LYNNE BROOKS PHONE: (210) FAX: (210) PHYSICAL ADDRESS : 6243 IH-10 WEST SUITE 375, SAN ANTONIO, TX CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: WILLIAMSON 1 CONSUMERS ENROLLED STATEWIDE 7 PROVIDER: 8V4 GABRIEL OLATUN GBAYISOMORE CONTRACT NUMBER : GABRIEL OLATUN GBAYISOMORE APPLICANT CONTACT: GABRIEL GBAYISOMORE PHONE: (817) FAX:

3 DATE PREPARED: D A D S REPORT NO.: HC TIME PREPARED: 03:37 HCS CDS AGENCY INFORMATION PAGE : 139 WAIVER CONTRACT AREA: 6 MRA: 460 BLUEBONNET TRAILS COMM. SVCS PHYSICAL ADDRESS : 4000 WILLOWRUN LANE, ARLINGTON, TX PROVIDER: 8PN GEOFFREY NZEADIBE CONTRACT NUMBER : LUCKY ENTERPRISE APPLICANT CONTACT: GEOFFREY NZEADIBE PHONE: (972) FAX: (469) PHYSICAL ADDRESS : 4510 HORIZON DRIVE, GARLAND, TX CONSUMERS ENROLLED STATEWIDE 37 PROVIDER: 8RQ HANDICAPPED RESOURCE ASSOCIATION CONTRACT NUMBER : HANDICAPPED RESOURCE ASSOCIATION APPLICANT CONTACT: VICKI NIEDERMAYER PHONE: (817) FAX: (817) PHYSICAL ADDRESS : 4300 BELTWAY PLACE, #130, ARLINGTON, TX CONSUMERS ENROLLED STATEWIDE 37 PROVIDER: 8PV IMAGINE ENTERPRISE, INC CONTRACT NUMBER : IMAGINE ENTERPRISE, INC. APPLICANT CONTACT: NORINE JALOWAY PHONE: (281) FAX: PHYSICAL ADDRESS : 1402 SPRING CRESS LANE, SEABROOK, TX CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: TRAVIS 1 WILLIAMSON 1 CONSUMERS ENROLLED STATEWIDE 60 PROVIDER: 8PS IN-HOME ATTENDANT SERVICES LTD CONTRACT NUMBER : IN-HOME ATTENDANT SERVICES LTD APPLICANT CONTACT: PATSY WH. LEGE PHONE: (713) FAX: PHYSICAL ADDRESS : 3333 FANNIN STE 109, HOUSTON, TX CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BELL 6 BRAZOS 6 TRAVIS 1 CONSUMERS ENROLLED STATEWIDE 45 PROVIDER: 842 MERIDIAN LIVING CENTER, INC CONTRACT NUMBER : MERIDIAN LIVING CENTER, INC APPLICANT CONTACT: LINER O. ANEKWE PHONE: (713) FAX: (713)

4 PHYSICAL ADDRESS : 3949 BRAXTON DRIVE, HOUSTON, TX CONSUMERS ENROLLED STATEWIDE 104 PROVIDER: 77W OLAWUMI O OLADEJI CONTRACT NUMBER : OLAWUMI O OLADEJI APPLICANT CONTACT: OLAWUMI OLADEJI PHONE: (469) FAX: (469) PHYSICAL ADDRESS : 611 KRISTI LN, CEDAR HILL, TX PROVIDER: 8WC OLUWATOSIN JOHNSON ADEESO

5 DATE PREPARED: D A D S REPORT NO.: HC TIME PREPARED: 03:37 HCS CDS AGENCY INFORMATION PAGE : 140 WAIVER CONTRACT AREA: 6 MRA: 460 BLUEBONNET TRAILS COMM. SVCS CONTRACT NUMBER : OLUWATOSIN JOHNSON ADEESO APPLICANT CONTACT: OLUWATOSIN J. ADEESO PHONE: (972) FAX: (214) PHYSICAL ADDRESS : GOLDENMARK DR,#401, DALLAS, TX PROVIDER: 8PP OUTREACH HEALTH COMMUNITY CARE CONTRACT NUMBER : OUTREACH HEALTH COMMUNITY CARE APPLICANT CONTACT: SHERRY CUMMINGS PHONE: (512) FAX: PHYSICAL ADDRESS : 505 EAST HUNTLAND, STE 520, AUSTIN, TX CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: TRAVIS 6 CONSUMERS ENROLLED STATEWIDE 16 PROVIDER: 8TA SADE J ONIS CONTRACT NUMBER : SADE J ONIS APPLICANT CONTACT: SAE J. ONIS PHONE: (832) FAX: PHYSICAL ADDRESS : 4231 BARROW RIDGE LANE, HOUSTON, TX PROVIDER: 8PR SEGNIK GROUP INC CONTRACT NUMBER : SEGNIK GROUP INC APPLICANT CONTACT: JOSHUA OYENIYI PHONE: (713) FAX: (713) PHYSICAL ADDRESS : 7001 CORPORATE DRIVE #215, HOUSTON, TX CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: BELL 2 BRAZOS 1 CORYELL 1 HAMILTON 1 TRAVIS 3 WILLIAMSON 1 CONSUMERS ENROLLED STATEWIDE 127 PROVIDER: 8RB VICTORIA Y JOHNSON CONTRACT NUMBER : VICTORIA Y JOHNSON APPLICANT CONTACT: VICTORIA Y. JOHNSON PHONE: (214) FAX: (214) PHYSICAL ADDRESS : ESDATE LN, DALLAS, TX CONSUMERS ENROLLED STATEWIDE 14

6 PROVIDER: 8WB YEKIBOLA INC CONTRACT NUMBER : YEKIBOLA,INC. APPLICANT CONTACT: YEKINI ANIMASHAUN PHONE: (832) FAX: (888) PHYSICAL ADDRESS : WILLIWAW DRIVE, HOUSTON, TX TOTAL NUMBER OF CONTRACTS THIS MRA: 19