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General NPI Number Information
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NPI Number | 1114431400
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Entity Type | Organization
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Legal Business Name | DESTINY'S WAY, LLC
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Dates
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Enumeration Date | 11/22/2017
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 4400B PORTSMOUTH BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23701-2542
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Country | US
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Telephone | 757-673-0719
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Fax |
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Provider Business Mailing Address
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Address Line | 115 BIRDIE DR
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City | SUFFOLK
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State | VA
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Zip | 23434-9283
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Country | US
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Telephone | 757-309-8612
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ARNE R JACKSON
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Credential | RN
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Telephone | 757-309-8612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO-1782
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License Number State | VA
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