Provider Demographics
NPI:1902311483
Name:DISTINCTIVE CARE HOME HEALTH & HOSPICE, LLC
Entity Type:Organization
Organization Name:DISTINCTIVE CARE HOME HEALTH & HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, WCC
Authorized Official - Phone:956-727-9111
Mailing Address - Street 1:6510 POLARIS DR. STE 2, ROOM # 2
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6510 POLARIS DR. STE. 2, ROOM #2
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-324-7689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health