Provider Demographics
NPI:1487980777
Name:DISTINCTIVE HOME CARE OF PALM BEACH, LLC
Entity type:Organization
Organization Name:DISTINCTIVE HOME CARE OF PALM BEACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-727-9142
Mailing Address - Street 1:533 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5420
Mailing Address - Country:US
Mailing Address - Phone:954-727-9142
Mailing Address - Fax:
Practice Address - Street 1:533 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5420
Practice Address - Country:US
Practice Address - Phone:954-727-9142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211391311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home