- Enrollment id
- O20091203000092
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1477788107
- Multiple npi flag
- N
- Ccn
- 747469
- Associate id
- 3274672373
- Organization name
- CLOVER HEALTH LLC
- Incorporation date
- 2009-05-01
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 400 CHISHOLM PL
- Address line 2
- SUITE 304, RM # 102
- City
- PLANO
- State
- TX
- Zip code
- 750756938