Provider Demographics
NPI:1265795124
Name:DISTINCT HOSPICE SERVICES, INC
Entity type:Organization
Organization Name:DISTINCT HOSPICE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNYBETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-319-0635
Mailing Address - Street 1:6671 VIANZA PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9024
Mailing Address - Country:US
Mailing Address - Phone:909-319-0635
Mailing Address - Fax:909-944-3878
Practice Address - Street 1:6671 VIANZA PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-9024
Practice Address - Country:US
Practice Address - Phone:909-319-0635
Practice Address - Fax:909-944-3878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based