MEDICARE: DESTINY'S CHILD 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	060-R-0096	GA

General Provider Information

NPI Number	:	1740349752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINY'S CHILD INC

Provider Business Mailing Address
First Line	:	3915 CASCADE RD SW
Second Line	:	SUITE 255
City	:	ATLANTA
State	:	GA
Zip	:	30331-8512
Country	:	US
Telephone Number	:	404-696-4400
Fax Number	:	404-696-4002

Provider Business Practice Location Address
First Line	:	3915 CASCADE RD SW
Second Line	:	SUITE 255
City	:	ATLANTA
State	:	GA
Zip	:	30331-8512
Country	:	US
Telephone Number	:	404-696-4400
Fax Number	:	404-696-4002

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. LORRAINE PRICE
Credential	:
Telephone Number	:	404-696-4400

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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