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General NPI Number Information
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NPI Number | 1114393832
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Entity Type | Organization
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Legal Business Name | DESTINY RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 1539 CAROLYN CT
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City | REDLANDS
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State | CA
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Zip | 92374-4738
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Country | US
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Telephone | 714-589-0676
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Fax |
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Provider Business Mailing Address
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Address Line | 1539 CAROLYN CT
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City | REDLANDS
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State | CA
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Zip | 92374-4738
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Country | US
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Telephone | 714-589-0676
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MORDECHAI RUBIN
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Credential |
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Telephone | 732-856-1069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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