=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285926949
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DESTINY HEALTHCARE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2011
-----------------------------------------------------
Last Update Date | 05/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10031 W ROOSEVELT RD STE 100
-----------------------------------------------------
City | WESTCHESTER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60154-2669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-450-1920
-----------------------------------------------------
Fax | 708-450-1921
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10031 W ROOSEVELT RD STE 100
-----------------------------------------------------
City | WESTCHESTER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60154-2669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-450-1920
-----------------------------------------------------
Fax | 708-450-1921
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. SYED NAJAMUDDIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-450-1920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 3001648
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1011943
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------