Provider Demographics
NPI:1174759385
Name:LONE STAR EXPEDITIONS, INC.
Entity type:Organization
Organization Name:LONE STAR EXPEDITIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C,
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-466-3838
Mailing Address - Street 1:1728 FOREST ROAD 5101
Mailing Address - Street 2:
Mailing Address - City:GROVETON
Mailing Address - State:TX
Mailing Address - Zip Code:75845
Mailing Address - Country:US
Mailing Address - Phone:936-831-3133
Mailing Address - Fax:
Practice Address - Street 1:1728 FOREST ROAD 5101
Practice Address - Street 2:
Practice Address - City:GROVETON
Practice Address - State:TX
Practice Address - Zip Code:75845
Practice Address - Country:US
Practice Address - Phone:936-831-3133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX822139322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children