MEDICARE: DESTINY CRITTENDON

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	3747P1801X	Personal Care Attendant		MI

General Provider Information

NPI Number	:	1982568093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY CRITTENDON

Provider Business Mailing Address
First Line	:	18531 MITCHELL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1551
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 E VERNOR HWY APT 301
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-2740
Country	:	US
Telephone Number	:	313-408-3670
Fax Number	:

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

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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Directions to “ DESTINY CRITTENDON ” Practice Location

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