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General NPI Number Information
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NPI Number | 1578252722
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Entity Type | Organization
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Legal Business Name | DESTINATIONS TO RECOVERY, LLC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 10461 QUAIL CANYON RD
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City | EL CAJON
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State | CA
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Zip | 92021-2242
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Country | US
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Telephone | 877-619-6707
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Fax | 818-737-2222
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Provider Business Mailing Address
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Address Line | 20951 BURBANK BLVD STE D
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-6696
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Country | US
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Telephone | 818-737-2221
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Fax | 818-737-2222
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL SAMSON
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Credential |
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Telephone | 818-650-9964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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