MEDICARE: DESTINYE STAFFING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QI0500X	Infusion Therapy Clinic/Center
2	251F00000X	Home Infusion Agency
3	251J00000X	Nursing Care Agency
4	261QA0600X	Adult Day Care Clinic/Center
5	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1235908658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINYE STAFFING SERVICES LLC

Provider Business Mailing Address
First Line	:	119 AUGUSTA PLANTATION DR UNIT F
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6440
Country	:	US
Telephone Number	:	909-590-5283
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 AUGUSTA PLANTATION DR UNIT F
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6440
Country	:	US
Telephone Number	:	909-590-5283
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELAINE MCLEAN
Credential	:
Telephone Number	:	909-590-5283

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	12/27/2023

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