- Enrollment id
- O20050106000504
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1578660098
- Multiple npi flag
- N
- Ccn
- 677827
- Associate id
- 5799733705
- Organization name
- ADVANCED HEALTHCARE SERVICES INC
- Incorporation date
- 2004-08-24
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 10707 CORPORATE DR
- Address line 2
- STE 140
- City
- STAFFORD
- State
- TX
- Zip code
- 774774092