Provider Demographics
NPI:1639539174
Name:DESTINY INTERNAL MEDICINE AND POST ACUTE CARE SERVICES PC
Entity Type:Organization
Organization Name:DESTINY INTERNAL MEDICINE AND POST ACUTE CARE SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMANO
Authorized Official - Middle Name:NTEELA
Authorized Official - Last Name:ABUABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-253-8473
Mailing Address - Street 1:7665 S EATON PARK CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4293
Mailing Address - Country:US
Mailing Address - Phone:720-324-4777
Mailing Address - Fax:720-262-4788
Practice Address - Street 1:1550 S POTOMAC ST STE 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5433
Practice Address - Country:US
Practice Address - Phone:720-324-4777
Practice Address - Fax:720-262-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
CO50289310400000X, 311500000X, 314000000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO483655OtherMEDICARE ID
COAAA2139Medicare PIN