Provider Demographics
NPI:1811192214
Name:DESTINATION HOPE
Entity Type:Organization
Organization Name:DESTINATION HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRAFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-771-2091
Mailing Address - Street 1:6460 NW 5TH WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6112
Mailing Address - Country:US
Mailing Address - Phone:954-771-2091
Mailing Address - Fax:954-771-2098
Practice Address - Street 1:6460 NW 5TH WAY
Practice Address - Street 2:SUITES 6458, 6456, 6454
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-6112
Practice Address - Country:US
Practice Address - Phone:954-771-2091
Practice Address - Fax:954-771-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
FL1706AD588401324500000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1045136OtherDCF IOP
FL1045135OtherDCF OP
FL1045134OtherDCF D/N LIC