- Enrollment id
- O20060110000767
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1548480353
- Multiple npi flag
- N
- Ccn
- 679517
- Associate id
- 8527081140
- Organization name
- MARTIN GRAHAM ENTERPRISES, LLC
- Doing business as name
- ADVANCED SENIOR CARE HOME HEALTH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1701 N COLLINS BLVD
- Address line 2
- STE 3000E
- City
- RICHARDSON
- State
- TX
- Zip code
- 750803564