- Enrollment id
- O20100330000877
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1932340015
- Multiple npi flag
- N
- Ccn
- 747599
- Associate id
- 4486780350
- Organization name
- GRACIOUS CARE HEALTH SERVICES INC
- Incorporation date
- 2009-01-06
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 777 S CENTRAL EXPY
- Address line 2
- STE 1F
- City
- RICHARDSON
- State
- TX
- Zip code
- 750807412