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General NPI Number Information
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NPI Number | 1710664735
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Entity Type | Organization
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Legal Business Name | DESTIN'D CARE PERSONAL SERVICE AGENCY
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Dates
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Enumeration Date | 06/30/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 3448 N RICHARDT AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-6364
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Country | US
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Telephone | 317-797-3794
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Fax |
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Provider Business Mailing Address
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Address Line | 3448 N RICHARDT AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-6364
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/MANAGER
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Name | DENISHEA BRYANT
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Credential |
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Telephone | 317-797-3794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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