Healthcare Provider Details

I. General information

NPI: 1861865818
Provider Name (Legal Business Name): DISTINCT HOME HEALTH CARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 MAXWELL PL.
PHILADELPHIA PA
19152
US

IV. Provider business mailing address

8900 MAXWELL PL.
PHILADELPHIA PA
19152
US

V. Phone/Fax

Practice location:
  • Phone: 215-713-5413
  • Fax:
Mailing address:
  • Phone: 215-713-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberRN:625738
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberRN:625738
License Number StatePA

VIII. Authorized Official

Name: MISS GLADYS CHARLEMAGNE
Title or Position: RN, BSN DIRECTOR
Credential: BSN, RN - REGISTERED
Phone: 215-713-5413