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General NPI Number Information
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NPI Number | 1477091775
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Entity Type | Organization
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Legal Business Name | DISTINCTIVE HOME CARE
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 2006 TULSON LANE A100
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City | BOWIE
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State | MD
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Zip | 20720-5633
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Country | US
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Telephone | 301-925-2900
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Fax | 301-925-2902
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Provider Business Mailing Address
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Address Line | 2006 TULSON LANE A100
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City | BOWIE
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State | MD
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Zip | 20720-5633
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Country | US
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Telephone | 301-925-2900
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Fax | 301-925-2902
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DEBORAH LORRAINE GUYNN
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Credential |
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Telephone | 301-925-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R2323
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License Number State | MD
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