- Enrollment id
- O20130820000806
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1952666539
- Multiple npi flag
- N
- Ccn
- 679009
- Associate id
- 6406098581
- Organization name
- VAN DYCK HOME CARE ENTERPRISES LLC
- Doing business as name
- LIFESPRING HOME CARE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 9608 BARTLETT CIR
- Address line 2
- STE 150
- City
- FORT WORTH
- State
- TX
- Zip code
- 761084449