MEDICARE: DISTINCTIVE HOME CARE, 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	30211309	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30211309	OTHER	FL	PRIVATE DUTY/NURSE REGIST

General Provider Information

NPI Number	:	1861676157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISTINCTIVE HOME CARE, LLC

Provider Business Mailing Address
First Line	:	33920 US HIGHWAY 19 N
Second Line	:	SUITE 341
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-2654
Country	:	US
Telephone Number	:	727-786-5520
Fax Number	:	727-787-6893

Provider Business Practice Location Address
First Line	:	6460 NW 5TH WAY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-6112
Country	:	US
Telephone Number	:	954-727-9142
Fax Number	:	954-727-2825

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

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	08/04/2008

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Directions to “DISTINCTIVE HOME CARE, LLC ” Practice Location

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