Healthcare Provider Details

I. General information

NPI: 1972134104
Provider Name (Legal Business Name): DESTINY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 LAWRENCE ST APT 18
LOWELL MA
01852-3593
US

IV. Provider business mailing address

270 LAWRENCE ST APT 18
LOWELL MA
01852-3593
US

V. Phone/Fax

Practice location:
  • Phone: 978-726-5310
  • Fax:
Mailing address:
  • Phone: 978-726-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HENRY MASEMBE
Title or Position: VICE PRESIDENT
Credential:
Phone: 781-492-0959