Provider Demographics
NPI:1467947101
Name:DESTINY SPRINGS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:DESTINY SPRINGS HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-233-2000
Mailing Address - Street 1:17300 N DYSART RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-4501
Mailing Address - Country:US
Mailing Address - Phone:623-233-3000
Mailing Address - Fax:
Practice Address - Street 1:17300 N. DYSART ROAD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378
Practice Address - Country:US
Practice Address - Phone:623-233-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital