- Enrollment id
- O20100607000154
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1831327014
- Multiple npi flag
- N
- Ccn
- 747574
- Associate id
- 1759411432
- Organization name
- MIRAGE HEALTHCARE SERVICES INC
- Incorporation date
- 2009-07-01
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2825 WILCREST DR
- Address line 2
- STE 518
- City
- HOUSTON
- State
- TX
- Zip code
- 770426041