MEDICARE: DESTINY RECOVERY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility	190939AP	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350529	OTHER	CA	CARF
2	190939AP	OTHER	CA	DHCS
3	621344	OTHER	CA	JOINT COMMISSION ACCREDITATION

General Provider Information

NPI Number	:	1548718190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINY RECOVERY INC

Provider Business Mailing Address
First Line	:	1042 E BELMONT ABBEY LN
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-1463
Country	:	US
Telephone Number	:	909-971-3333
Fax Number	:	909-498-9898

Provider Business Practice Location Address
First Line	:	1042 E BELMONT ABBEY LN
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-1463
Country	:	US
Telephone Number	:	909-971-3333
Fax Number	:	909-498-9898

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIANA ROZENOYER
Credential	:
Telephone Number	:	909-971-3333

Provider Enumeration Date	:	09/12/2016
Last Update Date	:	01/21/2026

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