Healthcare Provider Details

I. General information

NPI: 1114328416
Provider Name (Legal Business Name): DESTINATION LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2014
Last Update Date: 07/21/2022
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SE GREEN OAKS BLVD STE 130
ARLINGTON TX
76018-0952
US

IV. Provider business mailing address

2001 SE GREEN OAKS BLVD STE 130
ARLINGTON TX
76018-0952
US

V. Phone/Fax

Practice location:
  • Phone: 817-473-1312
  • Fax: 866-990-2813
Mailing address:
  • Phone: 817-473-1312
  • Fax: 866-990-2813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 11
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ZEMELDA D. CARR
Title or Position: ADM AND AUTH REP
Credential:
Phone: 817-473-1312