- Enrollment id
- O20100615000153
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1588800320
- Multiple npi flag
- N
- Ccn
- 747554
- Associate id
- 1456481621
- Organization name
- X-TRA HEALTHCARE SERVICES, INC
- Incorporation date
- 2008-07-01
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 777 S CENTRAL EXPY
- Address line 2
- STE 7H
- City
- RICHARDSON
- State
- TX
- Zip code
- 750807422