- Enrollment id
- O20251006000664
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1093177487
- Multiple npi flag
- N
- Ccn
- E21520
- Associate id
- 7517239049
- Organization name
- GRACEFULL, LLC
- Doing business as name
- PREMIER HOME HEALTH AGENCY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 4100 E PIEDRAS DR
- Address line 2
- STE 212
- City
- SAN ANTONIO
- State
- TX
- Zip code
- 782281401