Healthcare Provider Details

I. General information

NPI: 1477821767
Provider Name (Legal Business Name): DESTINY, POWER & PURPOSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 43RD PL NE
WASHINGTON DC
20019-3713
US

IV. Provider business mailing address

909 43RD PL NE
WASHINGTON DC
20019-3713
US

V. Phone/Fax

Practice location:
  • Phone: 202-399-1107
  • Fax: 202-399-1778
Mailing address:
  • Phone: 202-399-1107
  • Fax: 202-399-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH A CORLEY
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 202-369-0611