- Enrollment id
- O20100702000038
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1235373432
- Multiple npi flag
- N
- Ccn
- 747476
- Associate id
- 6204967474
- Organization name
- KINGS HEALTH CARE LLC.
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 9550 SKILLMAN STREET
- Address line 2
- SUITE 102
- City
- DALLAS
- State
- TX
- Zip code
- 752438261