- Enrollment id
- O20101007000811
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1578899001
- Multiple npi flag
- N
- Ccn
- 747567
- Associate id
- 5496947582
- Organization name
- CANAAN HOME HEALTHCARE AGENCY LLC
- Incorporation date
- 2009-09-08
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 9550 SKILLMAN STREET
- Address line 2
- SUITE 107
- City
- DALLAS
- State
- TX
- Zip code
- 75243