Provider Demographics
NPI:1154946077
Name:DISTINGUISHED SENIOR SERVICES
Entity type:Organization
Organization Name:DISTINGUISHED SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BATEMAN
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:AM
Authorized Official - Phone:336-710-7437
Mailing Address - Street 1:301 E MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3093
Mailing Address - Country:US
Mailing Address - Phone:336-710-7437
Mailing Address - Fax:
Practice Address - Street 1:301 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3093
Practice Address - Country:US
Practice Address - Phone:336-710-7437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health