MEDICARE: DESTINY HOME HEALTH AGENCY, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1609038231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINY HOME HEALTH AGENCY, INC

Provider Business Mailing Address
First Line	:	3300 S GESSNER RD STE 114
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5139
Country	:	US
Telephone Number	:	713-782-7400
Fax Number	:	713-782-7402

Provider Business Practice Location Address
First Line	:	3300 S GESSNER RD STE 114
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5139
Country	:	US
Telephone Number	:	713-782-7400
Fax Number	:	713-782-7402

Authorized Official
Title or Position	:	DON / ADMINISTRATOR
Name	:	LORETTA N ILOCHI
Credential	:	BSN/RN
Telephone Number	:	713-782-7400

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	12/05/2016

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