- Enrollment id
- O20120718000835
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1215216742
- Multiple npi flag
- N
- Ccn
- 747850
- Associate id
- 9133385115
- Organization name
- HIS GRACE HOME HEALTH CARE LLC
- Incorporation date
- 2011-08-16
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1201 N WATSON RD
- Address line 2
- STE 261
- City
- ARLINGTON
- State
- TX
- Zip code
- 760066190