Provider Demographics
NPI:1356003743
Name:DESTINY HEALTHCARE AND WELLNESS LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:DESTINY HEALTHCARE AND WELLNESS LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUDAPO
Authorized Official - Middle Name:RAPHAEL
Authorized Official - Last Name:ELUDOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:410-491-0962
Mailing Address - Street 1:6001 CHARLES EDWARD TER
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5147
Mailing Address - Country:US
Mailing Address - Phone:410-491-0962
Mailing Address - Fax:
Practice Address - Street 1:7060 OAKLAND MILLS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1694
Practice Address - Country:US
Practice Address - Phone:410-491-0962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty