Healthcare Provider Details

I. General information

NPI: 1952386914
Provider Name (Legal Business Name): DISTINGUISHED HOME HEALTH CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN STREET SUITE 206
COOPER CITY FL
33026-1531
US

IV. Provider business mailing address

11011 SHERIDAN STREET SUITE 206
COOPER CITY FL
33026-1531
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-2445
  • Fax: 954-987-2446
Mailing address:
  • Phone: 954-987-2445
  • Fax: 954-987-2446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA299991811
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299991811
License Number StateFL

VIII. Authorized Official

Name: ELIARDO BENOIT
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-987-2445