- Enrollment id
- O20070904000136
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1346364130
- Multiple npi flag
- N
- Ccn
- 747012
- Associate id
- 3476646720
- Organization name
- ESTAN HEALTHCARE SERVICES, INC.
- Incorporation date
- 2006-08-08
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 10707 CORPORATE DRIVE
- Address line 2
- SUITE 152
- City
- STAFFORD
- State
- TX
- Zip code
- 774774092