Provider Demographics
NPI:1417271669
Name:DESTINY ENTERPRISES, LLC
Entity Type:Organization
Organization Name:DESTINY ENTERPRISES, LLC
Other - Org Name:A TOUCH OF HOME NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:VANANTWERPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-444-5878
Mailing Address - Street 1:915 21ST ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4443
Mailing Address - Country:US
Mailing Address - Phone:218-444-5878
Mailing Address - Fax:218-444-5114
Practice Address - Street 1:915 21ST ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4443
Practice Address - Country:US
Practice Address - Phone:218-444-5878
Practice Address - Fax:218-444-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343410310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility