Provider Demographics
NPI:1770034001
Name:A DESTINY TO RECOVERY
Entity Type:Organization
Organization Name:A DESTINY TO RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:WAHEED
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-708-4126
Mailing Address - Street 1:1184 S GRAND HWY
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3203
Mailing Address - Country:US
Mailing Address - Phone:352-708-4126
Mailing Address - Fax:352-708-8291
Practice Address - Street 1:1184 S GRAND HWY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3203
Practice Address - Country:US
Practice Address - Phone:352-708-4126
Practice Address - Fax:352-708-8291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health