Provider Demographics
NPI:1881046019
Name:DESTINATIONS TO RECOVERY, LLC
Entity Type:Organization
Organization Name:DESTINATIONS TO RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ALON
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-737-2221
Mailing Address - Street 1:21051 WARNER CENTER LN
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6551
Mailing Address - Country:US
Mailing Address - Phone:818-737-2221
Mailing Address - Fax:818-737-2222
Practice Address - Street 1:9089 S PECOS RD
Practice Address - Street 2:SUITE 3500
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7183
Practice Address - Country:US
Practice Address - Phone:818-737-2221
Practice Address - Fax:818-737-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20161133893324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility