Provider Demographics
NPI:1023557840
Name:A DESTINY'S ROSE HCS, INC.
Entity Type:Organization
Organization Name:A DESTINY'S ROSE HCS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTIN-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-778-7228
Mailing Address - Street 1:PO BOX 543174
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054
Mailing Address - Country:US
Mailing Address - Phone:214-778-7228
Mailing Address - Fax:214-377-5009
Practice Address - Street 1:6330 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-3800
Practice Address - Country:US
Practice Address - Phone:214-778-7228
Practice Address - Fax:214-377-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX05Medicaid