- Enrollment id
- O20131124000002
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1407191612
- Multiple npi flag
- N
- Ccn
- 457893
- Associate id
- 1759530264
- Organization name
- MAXUS HEALTHCARE PARTNERS LLC
- Doing business as name
- RENEW HOME HEALTH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1021 WASHINGTON AVE.
- City
- FORT WORTH
- State
- TX
- Zip code
- 76104