Healthcare Provider Details

I. General information

NPI: 1457883779
Provider Name (Legal Business Name): DESTINATIONS WELLNESS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MAIN ST SUITE 501
NASHUA NH
03064-2776
US

IV. Provider business mailing address

33 MAIN ST SUITE 501
NASHUA NH
03064-2776
US

V. Phone/Fax

Practice location:
  • Phone: 603-943-5622
  • Fax: 603-943-5803
Mailing address:
  • Phone: 603-943-5622
  • Fax: 603-943-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number707
License Number StateNH

VIII. Authorized Official

Name: MR. DOUGLAS CLARK TAMPOSI JR.
Title or Position: OWNER
Credential:
Phone: 603-325-0954