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Organization
DISTINCTIVE HOMECARE LLC
Active
Organization
DISTINCTIVE HOMECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN DEGRAFT KOOMSON RN (PRESIDENT)
(267) 815-7307
Entity
Organization
Contact information
Practice address
9444 KIRKWOOD RD, PHILADELPHIA, PA 19114-2606
(267) 815-7307
Mailing address
9444 KIRKWOOD RD, PHILADELPHIA, PA 19114-2606
(267) 815-7307
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
—
NULL
163WG0000X
General Practice Registered Nurse
Primary
—
—
Other
Enumeration date
05/20/2020
Last updated
05/20/2020
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