MEDICARE: DISTINGUISHED HEALTHCARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1588516884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISTINGUISHED HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1209 WASHINGTON AVE APT 210
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1997
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 WASHINGTON AVE APT 210
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1997
Country	:	US
Telephone Number	:	314-537-1718
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	RONDA WALKER
Credential	:
Telephone Number	:	314-537-1718

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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