Provider Demographics
NPI:1356761449
Name:DISTINCTIVE HOME CARE
Entity type:Organization
Organization Name:DISTINCTIVE HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANTE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-925-2900
Mailing Address - Street 1:9500 ARENA DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-3701
Mailing Address - Country:US
Mailing Address - Phone:301-925-2900
Mailing Address - Fax:301-925-2902
Practice Address - Street 1:9500 ARENA DR
Practice Address - Street 2:SUITE 105
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3701
Practice Address - Country:US
Practice Address - Phone:301-925-2900
Practice Address - Fax:301-925-2902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2323251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health