Healthcare Provider Details

I. General information

NPI: 1023650488
Provider Name (Legal Business Name): DESTINY HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5752 ANDREA DR
NORFOLK VA
23518-5743
US

IV. Provider business mailing address

1035 BRYCE LN
VIRGINIA BEACH VA
23464-4500
US

V. Phone/Fax

Practice location:
  • Phone: 757-355-2215
  • Fax:
Mailing address:
  • Phone: 757-355-2215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. GLORIA BROWN MOORE
Title or Position: OWNER/CEO
Credential:
Phone: 757-355-2215