Provider Demographics
NPI:1881030807
Name:DESTINATIONAL TO HEALTH
Entity Type:Organization
Organization Name:DESTINATIONAL TO HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-730-0728
Mailing Address - Street 1:3380 NW 18TH PL
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33311-4236
Mailing Address - Country:US
Mailing Address - Phone:954-730-0728
Mailing Address - Fax:954-633-7146
Practice Address - Street 1:3380 NW 18TH PL
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33311-4236
Practice Address - Country:US
Practice Address - Phone:954-730-0728
Practice Address - Fax:954-633-7146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility