- Enrollment id
- O20240508003777
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1417494204
- Multiple npi flag
- N
- Ccn
- 748149
- Associate id
- 6800243858
- Organization name
- DEFAITH HOME HEALTH AGENCY INC
- Incorporation date
- 2022-10-27
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 777 S CENTRAL EXPY
- Address line 2
- STE 1F
- City
- RICHARDSON
- State
- TX
- Zip code
- 750807412