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General NPI Number Information
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NPI Number | 1942623061
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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 | 01/24/2014
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 22029 CANON DRIVE
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City | TOPANGA
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State | CA
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Zip | 90290
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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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Provider Business Mailing Address
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Address Line | 21051 WARNER CENTER LANE SUITE 220
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-6592
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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 | MR. DANIEL SAMSON
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Credential |
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Telephone | 818-737-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 197608637
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License Number State | CA
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