MEDICARE: DISTINCTIVE HOME CARE OF PALM BEACH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	30211391	FL

General Provider Information

NPI Number	:	1487980777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISTINCTIVE HOME CARE OF PALM BEACH, LLC

Provider Business Mailing Address
First Line	:	533 NORTHLAKE BLVD
Second Line	:	SUITE 4
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5420
Country	:	US
Telephone Number	:	954-727-9142
Fax Number	:

Provider Business Practice Location Address
First Line	:	533 NORTHLAKE BLVD
Second Line	:	SUITE 4
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5420
Country	:	US
Telephone Number	:	954-727-9142
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHARON HUGGINS
Credential	:
Telephone Number	:	954-727-9142

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	10/22/2009

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