- Enrollment id
- O20101015000422
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1649538695
- Multiple npi flag
- N
- Ccn
- 747513
- Associate id
- 4587656467
- Organization name
- JP AND P HEALTHCARE AGENCY INC
- Incorporation date
- 2011-10-19
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 11551 FOREST CENTRAL DR
- Address line 2
- STE 101
- City
- DALLAS
- State
- TX
- Zip code
- 752433913