Provider Demographics
NPI:1013555069
Name:DESTINATIONS TO RECOVERY, LLC
Entity Type:Organization
Organization Name:DESTINATIONS TO RECOVERY, LLC
Other - Org Name:DESTINATIONS FOR TEENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-737-2221
Mailing Address - Street 1:20951 BURBANK BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6696
Mailing Address - Country:US
Mailing Address - Phone:818-650-9964
Mailing Address - Fax:
Practice Address - Street 1:22842 HATTERAS ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-4231
Practice Address - Country:US
Practice Address - Phone:818-737-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESTINATIONS TO RECOVERY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-19
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility