- Enrollment id
- O20250328002614
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1386417392
- Multiple npi flag
- N
- Ccn
- 748165
- Associate id
- 7618490772
- Organization name
- MED-CERT PAS SERVICES LLC
- Incorporation date
- 2023-07-26
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1919 S SHILOH RD
- Address line 2
- STE 655
- City
- GARLAND
- State
- TX
- Zip code
- 750428211
- Practice location type
- HHA BRANCH