Provider Demographics
NPI:1871963595
Name:DISTINCT CARE HEALTH SERVICES
Entity type:Organization
Organization Name:DISTINCT CARE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-517-1922
Mailing Address - Street 1:1205 N MEYER ST
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-1693
Mailing Address - Country:US
Mailing Address - Phone:973-517-1922
Mailing Address - Fax:
Practice Address - Street 1:1205 N MEYER ST STE 5
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-1694
Practice Address - Country:US
Practice Address - Phone:973-517-1922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DISTINCT CARE HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-07
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health