DISTINCTIVE HOMECARE LLC (NPI# 1013530443) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013530443 |
| Entity Type | Organization |
| Organization Name | DISTINCTIVE HOMECARE LLC |
| Practice Address |
9444 Kirkwood Rd Philadelphia PA 19114-2606 |
| Practice Telephone | 2678157307 |
| Mailing Telephone | 2678157307 |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2020-05-20 |
| Authorized Official Name | BENJAMIN DEGRAFT KOOMSON (PRESIDENT) |
| Authorized Official Telephone | 2678157307 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WG0000X |
Registered Nurse Specialization: General Practice |
Nursing Service Providers |
| Street Address |
9444 KIRKWOOD RD |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19114-2606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164029906 | Phuoc Nguyen | Nurse Anesthetist, Certified Registered | Jefferson Torresdale Hospital, 10800 Knights Rd, Philadelphia, PA 19114 | 2020-10-05 |
| 1053921932 | Priyanka Patel | Dentist | Philadelphia Dental Smiles, 9140 Academy Road, Philadelphia, PA 19114 | 2020-08-05 |
| 1215419080 | Thomas Patrick Gallagher | Specialist/Technologist | 2708 Ruth Way, Philadelphia, PA 19114 | 2018-08-29 |
| 1558840223 | Alexis Wenger | Early Intervention Provider Agency | 3810 Aubrey Ave, Phila, PA 19114 | 2018-08-13 |
| 1245759232 | Newlands Health | Clinic/Center | 9625 Frankford Ave., Philadelphia, PA 19114 | 2017-09-12 |
| 1619491453 | Nazareth Physician Services Inc | Social Worker | 9815 Roosevelt Blvd Ste G, Philadelphia, PA 19114 | 2017-08-02 |
| 1326561606 | L.s. Share & Love Support Coordinating Agency, LLC | Case Management | 3600 Red Lion Road, Apt 68c, Philadelphia, PA 19114 | 2017-07-19 |
| 1760911952 | Charles C Richards II | Counselor | 2555 Welsh Rd, Apt 407, Philadelphia, PA 19114 | 2017-06-09 |
| 1801338686 | April Neuls | Physical Therapy Assistant | 4213 Lackland Place, Philadelphia, PA 19114 | 2016-11-10 |
| 1114317583 | Siji Cyriac | Physical Therapist | 9501 State Road, Philadelphia, PA 19114 | 2015-01-23 |
| Find all providers in zip 19114 | ||||
| Taxonomy Code | 163WG0000X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467921015 | Francis Chiejine | Registered Nurse | 6200-b Woodland Ave, 2nd Floor, Philadelphia, PA 19142 | 2018-11-13 |
| 1003457037 | Leah Fesi | Registered Nurse | 100 W Oxford St, Philadelphia, PA 19122-3927 | 2019-10-01 |
| 1629564307 | Ana Luisa Perez Guerrero | Registered Nurse | 5201 Haverford Ave, Philadelphia, PA 19139-1401 | 2018-07-06 |
| 1235636317 | Ashley Renee Easterling | Registered Nurse | 111 S 11th St Ste G8490, Philadelphia, PA 19107-4824 | 2018-04-06 |
| 1548799059 | Charlotte Scott | Registered Nurse | 1632 Pine St, Philadelphia, PA 19103 | 2017-06-08 |
| 1740632801 | Theresa Twegbe | Registered Nurse | 8220 Castor Ave, Philadelphia, PA 19152-2729 | 2016-07-12 |
| 1972821064 | Analiza P Guerrero | Registered Nurse | 4453 Castor Ave, Suite B, Philadelphia, PA 19124-3846 | 2010-05-13 |
| 1801065842 | Jeannie M Peake | Registered Nurse | 8125 Stenton Ave, Philadelphia, PA 19150-3530 | 2008-02-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205435542 | Peggy Hudelson | Registered Nurse | 1637 Honey Hole Rd, White Haven, PA 18661-3405 | 2020-10-19 |
| 1811557465 | Julie Ann Bannar | Registered Nurse | 6550 Madison St, New Tripoli, PA 18066-3936 | 2019-06-17 |
| 1053878652 | Nicole Gozdan | Registered Nurse | 304 Woods Rd, Glenside, PA 19038-1429 | 2019-03-01 |
| 1972067460 | Ashley Cristiano | Registered Nurse | 271 Lelia St, Pittsburgh, PA 15211-2329 | 2019-01-29 |
| 1982111001 | Shirley Marie Tolbert | Registered Nurse | 7111 Jonathan Place, Pittsburgh, PA 15221-2419 | 2018-01-10 |
| 1962915462 | Sheri Lynn Davis | Registered Nurse | 371 Apple St, Fleming, PA 16835-0039 | 2017-11-07 |
| 1275052334 | Heather D Lawrence | Registered Nurse | 440 Entry Rd, Aultman, PA 15713-9601 | 2017-09-11 |
| 1164945838 | Kimberly Anne Harvey | Registered Nurse | 2625 Market Pl Ste 2, Harrisburg, PA 17110-9362 | 2017-07-25 |
| 1013393370 | Wayne Wrolstad | Registered Nurse | 7 Madonna Ln, Broomall, PA 19008-2264 | 2015-08-09 |
| 1598159824 | Treesa Williamson | Registered Nurse | Advance Behavioral Health Treatment Center, 830 Chestnut St. Suite 1, Royersford, PA 19468 | 2015-03-25 |
| Find all providers with the same taxonomy | ||||
| City | PHILADELPHIA |
| Zip Code | 19114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.