- Enrollment id
- O20170818000522
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1093177487
- Multiple npi flag
- N
- Ccn
- 679655
- Associate id
- 7517239049
- Organization name
- GRACEFULL, LLC
- Doing business as name
- PREMIER HOME HEALTH AGENCY
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 4100 E PIEDRAS DR
- Address line 2
- STE 212
- City
- SAN ANTONIO
- State
- TX
- Zip code
- 782281401