- Enrollment id
- O20020921000006
- Enrollment state
- AR
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1376536003
- Multiple npi flag
- N
- Ccn
- 047114
- Associate id
- 0648187450
- Organization name
- JORDAN HOME HEALTH CARE, LLC
- Doing business as name
- ELARA CARING
- Incorporation date
- 2002-07-15
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 4102 JEFFERSON AVE
- City
- TEXARKANA
- State
- AR
- Zip code
- 718541512