MEDICARE: DESTINY M LODGE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	171M00000X	Case Manager/Care Coordinator
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1710853775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY M LODGE

Provider Business Mailing Address
First Line	:	27801 EUCLID AVE STE 600
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44132-3548
Country	:	US
Telephone Number	:	216-337-1411
Fax Number	:	216-223-8938

Provider Business Practice Location Address
First Line	:	27801 EUCLID AVE STE 600
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44132-3548
Country	:	US
Telephone Number	:	216-337-1411
Fax Number	:	216-223-8938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	10/15/2025

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Directions to “ DESTINY M LODGE ” Practice Location

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