Provider Demographics
NPI:1225046683
Name:DISTINGUISHED HOME SERVICES LLC
Entity Type:Organization
Organization Name:DISTINGUISHED HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COURTNEE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-743-1734
Mailing Address - Street 1:6031 E MAIN ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3356
Mailing Address - Country:US
Mailing Address - Phone:614-743-1734
Mailing Address - Fax:
Practice Address - Street 1:1500 BRICE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2341
Practice Address - Country:US
Practice Address - Phone:614-743-1734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251C00000X
251E00000X
OH25800070347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle