MEDICARE: A & B DESTINY CARE LLC

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	:	1982224408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A & B DESTINY CARE LLC

Provider Business Mailing Address
First Line	:	20219 WEEPING PINE WAY
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20219 WEEPING PINE WAY
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2033
Country	:	US
Telephone Number	:	832-713-4941
Fax Number	:

Authorized Official
Title or Position	:	ALT. ADMINISTRATOR
Name	:	OLASIMBO BODE
Credential	:
Telephone Number	:	832-713-4941

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	04/24/2020

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Directions to “A & B DESTINY CARE LLC ” Practice Location

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