- Enrollment id
- O20181019001922
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1275013385
- Multiple npi flag
- N
- Ccn
- 679244
- Associate id
- 3779836846
- Organization name
- DESTINYS HOME HEALTH CARE LLC
- Incorporation date
- 2018-08-09
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 337 OAKS TRAIL
- Address line 2
- STE 104
- City
- GARLAND
- State
- TX
- Zip code
- 750438028