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General NPI Number Information
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NPI Number | 1750484085
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Entity Type | Organization
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Legal Business Name | DESTINY HOME HEALTH AGENCY INC
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 12981 PERRIS BLVD, SUITE 214
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City | MORENO VALLEY
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State | CA
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Zip | 92553-4112
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Country | US
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Telephone | 951-242-1365
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Fax | 951-242-1387
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Provider Business Mailing Address
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Address Line | PO BOX 1000
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City | MORENO VALLEY
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State | CA
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Zip | 92556-1000
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Country | US
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Telephone | 951-242-1365
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOY NSEMEKE EKPO
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Credential |
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Telephone | 951-242-1365
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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 | 250000800
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License Number State | CA
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