MEDICARE: DESTINY BASE HOME HEALTH SERVICES, 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	010833	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010833	OTHER	TX	HOME CARE LICENSE

General Provider Information

NPI Number	:	1811225238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINY BASE HOME HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	329 OAKS TRL
Second Line	:	SUITE 200
City	:	GARLAND
State	:	TX
Zip	:	75043-4092
Country	:	US
Telephone Number	:	214-777-2391
Fax Number	:	972-203-0020

Provider Business Practice Location Address
First Line	:	329 OAKS TRL
Second Line	:	SUITE 200
City	:	GARLAND
State	:	TX
Zip	:	75043-4092
Country	:	US
Telephone Number	:	214-777-2391
Fax Number	:	972-203-0020

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. FELIX OGBEIDE
Credential	:
Telephone Number	:	214-777-2391

Provider Enumeration Date	:	11/23/2009
Last Update Date	:	11/23/2009

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