Provider Demographics
NPI:1023184843
Name:DESTINY HOSPICE PALLIATIVE CARE, SPECIALTY SERVICES, INC.
Entity Type:Organization
Organization Name:DESTINY HOSPICE PALLIATIVE CARE, SPECIALTY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEOOWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALPHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:251-665-1063
Mailing Address - Street 1:3759 GOVENMENT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693
Mailing Address - Country:US
Mailing Address - Phone:251-665-1093
Mailing Address - Fax:251-665-1098
Practice Address - Street 1:3759 GOVERNMENT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-4307
Practice Address - Country:US
Practice Address - Phone:251-665-1093
Practice Address - Fax:251-665-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL011641251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011641Medicare ID - Type UnspecifiedHOSPICE