DATE PREPARED: 05-18-13 D A D S REPORT NO.: HC062098 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 : 001009120 ABILITY CONNECTION TEXAS APPLICANT CONTACT: REBECCA ADAMS PHONE: (214) 926-2262 FAX: (214) 351-2610 PHYSICAL ADDRESS : 8802 HARRY HINES BLVD, DALLAS, TX 75235 CONSUMERS ENROLLED STATEWIDE 317 PROVIDER: 8WA ALAMO CONSUMER DIRECT LLC CONTRACT NUMBER : 001009084 ALAMO CONSUMER DIRECT LLC 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: CALDWELL 1 MCLENNAN 1 TRAVIS 2 WILLIAMSON 1 CONSUMERS ENROLLED STATEWIDE 92 PROVIDER: 837 COMMUNITY ACCESS INC CONTRACT NUMBER : 001009044 COMMUNITY ACCESS INC 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 1 CONSUMERS ENROLLED STATEWIDE 421 PROVIDER: 8TE CONSUMER DIRECTED SERVICES IN TEXAS, INC. CONTRACT NUMBER : 001008729 CONSUMER DIRECTED SERVICES IN TEXAS, INC. 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: BELL 3 BRAZOS 2 GUADALUPE 2 TRAVIS 9 CONSUMERS ENROLLED STATEWIDE 116 PROVIDER: 8W6 CROWNCARE MANAGEMENTS LLC CONTRACT NUMBER : 001009040 CROWNCARE MANAGEMENTS, LLC APPLICANT CONTACT: BERNADETTE KEKE PHONE: (832) 260-3763 FAX: (281) 238-0768 PHYSICAL ADDRESS : 1123 DEEP RIVER DRIVE, RICHMOND, TX 77469 CONSUMERS ENROLLED STATEWIDE 1
PROVIDER: 812 DISABILITY SERVICES OF THE SOUTHWEST, INC. CONTRACT NUMBER : 001008507 DISABILITY SERVICES OF THE SOUTHWEST,INC. APPLICANT CONTACT: LYNNE BROOKS PHONE: (210) 798-0123 FAX: (210) 798-1135 PHYSICAL ADDRESS : 6243 IH-10 WEST SUITE 375, SAN ANTONIO, TX 78201 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: WILLIAMSON 1 CONSUMERS ENROLLED STATEWIDE 7 PROVIDER: 8V4 GABRIEL OLATUN GBAYISOMORE CONTRACT NUMBER : 001008710 GABRIEL OLATUN GBAYISOMORE APPLICANT CONTACT: GABRIEL GBAYISOMORE PHONE: (817) 704-3312 FAX:
DATE PREPARED: 05-18-13 D A D S REPORT NO.: HC062098 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 76013 PROVIDER: 8PN GEOFFREY NZEADIBE CONTRACT NUMBER : 001008296 LUCKY ENTERPRISE APPLICANT CONTACT: GEOFFREY NZEADIBE PHONE: (972) 303-2800 FAX: (469) 442-0647 PHYSICAL ADDRESS : 4510 HORIZON DRIVE, GARLAND, TX 75014 CONSUMERS ENROLLED STATEWIDE 37 PROVIDER: 8RQ HANDICAPPED RESOURCE ASSOCIATION CONTRACT NUMBER : 001008516 HANDICAPPED RESOURCE ASSOCIATION APPLICANT CONTACT: VICKI NIEDERMAYER PHONE: (817) 469-1977 FAX: (817) 461-2334 PHYSICAL ADDRESS : 4300 BELTWAY PLACE, #130, ARLINGTON, TX 76018 CONSUMERS ENROLLED STATEWIDE 37 PROVIDER: 8PV IMAGINE ENTERPRISE, INC CONTRACT NUMBER : 001008317 IMAGINE ENTERPRISE, INC. APPLICANT CONTACT: NORINE JALOWAY PHONE: (281) 474-7887 FAX: PHYSICAL ADDRESS : 1402 SPRING CRESS LANE, SEABROOK, TX 77586 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: TRAVIS 1 WILLIAMSON 1 CONSUMERS ENROLLED STATEWIDE 60 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 6 BRAZOS 6 TRAVIS 1 CONSUMERS ENROLLED STATEWIDE 45 PROVIDER: 842 MERIDIAN LIVING CENTER, INC CONTRACT NUMBER : 001009143 MERIDIAN LIVING CENTER, INC APPLICANT CONTACT: LINER O. ANEKWE PHONE: (713) 778-9300 FAX: (713) 778-9313
PHYSICAL ADDRESS : 3949 BRAXTON DRIVE, HOUSTON, TX 77063 CONSUMERS ENROLLED STATEWIDE 104 PROVIDER: 77W OLAWUMI O OLADEJI CONTRACT NUMBER : 001009879 OLAWUMI O OLADEJI APPLICANT CONTACT: OLAWUMI OLADEJI PHONE: (469) 765-2873 FAX: (469) 375-3983 PHYSICAL ADDRESS : 611 KRISTI LN, CEDAR HILL, TX 75104 PROVIDER: 8WC OLUWATOSIN JOHNSON ADEESO
DATE PREPARED: 05-18-13 D A D S REPORT NO.: HC062098 TIME PREPARED: 03:37 HCS CDS AGENCY INFORMATION PAGE : 140 WAIVER CONTRACT AREA: 6 MRA: 460 BLUEBONNET TRAILS COMM. SVCS CONTRACT NUMBER : 001009102 OLUWATOSIN JOHNSON ADEESO APPLICANT CONTACT: OLUWATOSIN J. ADEESO PHONE: (972) 664-1300 FAX: (214) 544-7204 PHYSICAL ADDRESS : 13999 GOLDENMARK DR,#401, DALLAS, TX 75240-4270 PROVIDER: 8PP OUTREACH HEALTH COMMUNITY CARE CONTRACT NUMBER : 001008203 OUTREACH HEALTH COMMUNITY CARE APPLICANT CONTACT: SHERRY CUMMINGS PHONE: (512) 692-7810 FAX: PHYSICAL ADDRESS : 505 EAST HUNTLAND, STE 520, AUSTIN, TX 78751 CONSUMERS ENROLLED IN THE FOLLOWING COUNTIES: TRAVIS 6 CONSUMERS ENROLLED STATEWIDE 16 PROVIDER: 8TA SADE J ONIS CONTRACT NUMBER : 001008526 SADE J ONIS APPLICANT CONTACT: SAE J. ONIS PHONE: (832) 881-9802 FAX: PHYSICAL ADDRESS : 4231 BARROW RIDGE LANE, HOUSTON, TX 77082 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 2 BRAZOS 1 CORYELL 1 HAMILTON 1 TRAVIS 3 WILLIAMSON 1 CONSUMERS ENROLLED STATEWIDE 127 PROVIDER: 8RB VICTORIA Y JOHNSON CONTRACT NUMBER : 001008551 VICTORIA Y JOHNSON APPLICANT CONTACT: VICTORIA Y. JOHNSON PHONE: (214) 405-8523 FAX: (214) 405-8523 PHYSICAL ADDRESS : 10935 ESDATE LN, DALLAS, TX 75238 CONSUMERS ENROLLED STATEWIDE 14
PROVIDER: 8WB YEKIBOLA INC CONTRACT NUMBER : 001009093 YEKIBOLA,INC. APPLICANT CONTACT: YEKINI ANIMASHAUN PHONE: (832) 455-6308 FAX: (888) 241-5301 PHYSICAL ADDRESS : 15915 WILLIWAW DRIVE, HOUSTON, TX 77083 TOTAL NUMBER OF CONTRACTS THIS MRA: 19