- Enrollment id
- O20120425000606
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1477751568
- Multiple npi flag
- N
- Ccn
- 679279
- Associate id
- 8325958606
- Organization name
- LIFEGATE HEALTHCARE SERVICES INC
- Incorporation date
- 2002-05-31
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 310 E I30
- Address line 2
- STE B 105
- City
- GARLAND
- State
- TX
- Zip code
- 750434047