- Enrollment id
- O20101013001167
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1083942056
- Multiple npi flag
- N
- Ccn
- 747507
- Associate id
- 2365634961
- Organization name
- MED-CERT HOME CARE ,LLC
- Doing business as name
- MED-CERT HOME CARE LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1919 S SHILOH RD
- Address line 2
- STE 660
- City
- GARLAND
- State
- TX
- Zip code
- 750428234