MEDICARE: DESTINYE STAFFING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163W00000X	Registered Nurse
2	177F00000X	Lodging Provider
3	251F00000X	Home Infusion Agency
4	251G00000X	Community Based Hospice Care Agency
5	251J00000X	Nursing Care Agency
6	253Z00000X	In Home Supportive Care Agency
7	261QA0600X	Adult Day Care Clinic/Center
8	302F00000X	Exclusive Provider Organization
9	302R00000X	Health Maintenance Organization
10	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1043776909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINYE STAFFING SERVICES

Provider Business Mailing Address
First Line	:	1323 W RIVERVIEW AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-6216
Country	:	US
Telephone Number	:	908-590-5283
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 AUGUSTA PLANTATION DR UNIT F
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6440
Country	:	US
Telephone Number	:	908-590-5283
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELAINE MCLEAN
Credential	:	RN
Telephone Number	:	908-590-5283

Provider Enumeration Date	:	02/15/2019
Last Update Date	:	12/27/2023

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