Provider Demographics
NPI:1255917936
Name:DISTINCT HOME HEALTH SERVICE LLC
Entity type:Organization
Organization Name:DISTINCT HOME HEALTH SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALENI-ODEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-554-2234
Mailing Address - Street 1:2832 N CAMINO LAGOS
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6755
Mailing Address - Country:US
Mailing Address - Phone:682-554-2234
Mailing Address - Fax:214-988-2024
Practice Address - Street 1:2832 N CAMINO LAGOS
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6755
Practice Address - Country:US
Practice Address - Phone:682-554-2234
Practice Address - Fax:214-988-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health