Healthcare Provider Details

I. General information

NPI: 1881029445
Provider Name (Legal Business Name): DESTIN RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LEGENDARY DR SUITE 270
DESTIN FL
32541-8601
US

IV. Provider business mailing address

10065 US HIGHWAY 98 W SUITE B101
MIRAMAR BEACH FL
32550-4924
US

V. Phone/Fax

Practice location:
  • Phone: 855-638-7258
  • Fax: 850-837-4352
Mailing address:
  • Phone: 850-837-8005
  • Fax: 850-837-4352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLY REEVES
Title or Position: OWNER
Credential: RN
Phone: 850-259-6396