Healthcare Provider Details

I. General information

NPI: 1922701390
Provider Name (Legal Business Name): DESTINY HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 CAMINO RAMON
SAN RAMON CA
94583-1353
US

IV. Provider business mailing address

2252 CAMINO RAMON
SAN RAMON CA
94583-1353
US

V. Phone/Fax

Practice location:
  • Phone: 925-275-1600
  • Fax: 925-275-1600
Mailing address:
  • Phone: 925-275-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MOREMI OYEDELE
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 925-208-9766