Provider Demographics
NPI:1841422524
Name:DESTINY HOME CARE
Entity Type:Organization
Organization Name:DESTINY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:UDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-888-7172
Mailing Address - Street 1:10061 HARRIET AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-4726
Mailing Address - Country:US
Mailing Address - Phone:952-888-7172
Mailing Address - Fax:952-888-7724
Practice Address - Street 1:9907 WENTWORTH AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-4830
Practice Address - Country:US
Practice Address - Phone:952-888-7171
Practice Address - Fax:952-888-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health