Healthcare Provider Details

I. General information

NPI: 1467446856
Provider Name (Legal Business Name): DISTINGUISHED HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 N 1ST ST
MERKEL TX
79536-3086
US

IV. Provider business mailing address

1704 N 1ST ST
MERKEL TX
79536-3086
US

V. Phone/Fax

Practice location:
  • Phone: 325-928-5673
  • Fax: 325-928-3011
Mailing address:
  • Phone: 325-928-5673
  • Fax: 325-928-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4122
License Number StateTX

VIII. Authorized Official

Name: MR. STORMIE JONES
Title or Position: PRESIDENT
Credential: LNFA
Phone: 254-647-3111