Distinctive Homecare LLC
Registered Nurse, General Practice in Philadelphia, PA. Organization (NPI-2).
Details
- NPI
- 1013530443
- Entity type
- Organization (NPI-2)
- Legal business name
- Distinctive Homecare LLC
- Organization subpart
- No
- Enumeration date
- May 20, 2020
- Certification date
- May 20, 2020
- Last updated
- May 20, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163WG0000X | Registered Nurse, General Practice | – | – | Yes |
Practice location
9444 Kirkwood RdPhiladelphia, PA 19114-2606
Phone 267-815-7307
Mailing address
9444 Kirkwood RdPhiladelphia, PA 19114-2606
Phone 267-815-7307
Authorized official
Benjamin Degraft Koomson
President
2678157307
Is something wrong?
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