Provider Demographics
NPI:1245625573
Name:DISTINGUISHED DIRECTION
Entity type:Organization
Organization Name:DISTINGUISHED DIRECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAREKIA
Authorized Official - Middle Name:FELDER
Authorized Official - Last Name:WEARING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-779-5752
Mailing Address - Street 1:324 WILDOL ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29059-8545
Mailing Address - Country:US
Mailing Address - Phone:803-971-1585
Mailing Address - Fax:
Practice Address - Street 1:324 WILDOL ST
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:SC
Practice Address - Zip Code:29059-8545
Practice Address - Country:US
Practice Address - Phone:803-971-1585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health