Provider Demographics
NPI:1912879503
Name:HUBBARD, DESTINY DASHONNA
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:DASHONNA
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22701 HADDEN RD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2157
Mailing Address - Country:US
Mailing Address - Phone:216-327-4816
Mailing Address - Fax:
Practice Address - Street 1:22701 HADDEN RD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2157
Practice Address - Country:US
Practice Address - Phone:216-327-4816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 253Z00000X, 372600000X
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No372600000XNursing Service Related ProvidersAdult Companion