Provider Demographics
NPI:1205537750
Name:DESTINATION HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:DESTINATION HEALTHCARE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:OSAITILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:161-563-8745
Mailing Address - Street 1:435 METROPLEX DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3109
Mailing Address - Country:US
Mailing Address - Phone:615-638-7455
Mailing Address - Fax:
Practice Address - Street 1:435 METROPLEX DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3109
Practice Address - Country:US
Practice Address - Phone:615-638-7455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities