DESTINATION LIFE LLC (NPI# 1831712413) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831712413 |
| Entity Type | Organization |
| Organization Name | DESTINATION LIFE LLC |
| Other Organization Name | DESTINATION THERAPY |
| Practice Address |
1759 Broad Park Cir S Ste 113 Mansfield TX 76063-7836 |
| Practice Telephone | 8174731312 |
| Practice Fax Number | 8669902813 |
| Mailing Telephone | 8174731312 |
| Mailing Fax Number | 8669902813 |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2020-09-03 |
| Authorized Official Name | ZEMELDA D. CARR (ADM & AUTH REP) |
| Authorized Official Telephone | 8174731312 |
| Is Organization Subpart | Y |
| Parent Organization Name | DESTINATION LIFE LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities | ||
| N | 261QH0700X |
Clinic/Center Specialization: Hearing and Speech |
Ambulatory Health Care Facilities | ||
| N | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities | ||
| Y | 261QR0401X |
Clinic/Center Specialization: Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | THERAPY CLINIC | 567960000 | 01 |
| Other Name | Type Code |
|---|---|
| Destination Therapy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114328416 | Destination Life LLC | Registered Nurse | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2014-09-06 |
| 1629691167 | Destination Life LLC | Social Worker | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-05-19 |
| 1588287163 | Destination Life LLC | Durable Medical Equipment & Medical Supplies | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-05-18 |
| Street Address |
1759 BROAD PARK CIR S STE 113 |
| City | MANSFIELD |
| State | TX |
| Zip Code | 76063-7836 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114328416 | Destination Life LLC | Registered Nurse | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2014-09-06 |
| 1821699588 | My Nguyen | Registered Nurse | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-11-07 |
| 1023625894 | Sajourney Pllc | Social Worker | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-09-25 |
| 1356955884 | Amber S Lockett | Social Worker | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-09-02 |
| 1134730880 | Lauren E Moss | Social Worker | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-08-14 |
| 1275159774 | Melanie Canas | Registered Nurse | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-06-19 |
| 1891319000 | Keri Jo Coleman | Registered Nurse | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-06-03 |
| 1629691167 | Destination Life LLC | Social Worker | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-05-19 |
| 1588287163 | Destination Life LLC | Durable Medical Equipment & Medical Supplies | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-05-18 |
| 1790214989 | Xaquita Wicks | Registered Nurse | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2017-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316558349 | Lindsey Vandyke, D.o. Pllc | Internal Medicine | 3150 E Broad Street, Ste 100, Mansfield, TX 76063 | 2020-08-13 |
| 1942819867 | Jennifer Que Chau Nguyen | Pharmacist | 980 U.S. 287 Frontage Rd #287, Mansfield, TX 76063 | 2020-07-27 |
| 1194346890 | Ana Maria Gonzalez | Dentist | 1600 Us Highway 287, Suite 102, Mansfield, TX 76063 | 2020-05-04 |
| 1245869080 | Stateserv Medical of Texas, LLC | Durable Medical Equipment & Medical Supplies | 7941 Rodeo Trail, Mansfield, TX 76063 | 2020-04-03 |
| 1649802232 | Mary Puanani Kamai | Nurse Practitioner | 1301 E. Debbie Lane, Suite 102 #1405, Mansfield, TX 76063 | 2020-02-11 |
| 1770123028 | Gladys Vera Nfodzo | Nurse Practitioner | 901 W. Broad St, Mansfield, TX 76063 | 2020-01-14 |
| 1669011300 | Alexa Smith | Nurse Practitioner | 2800 E Broad St #304, Mansfield, TX 76063 | 2019-12-28 |
| 1477190437 | Mel Rockwall LLC | Optometrist | 1701 East Broad Street, Ste 109, Mansfield, TX 76063 | 2019-12-09 |
| 1376185512 | Daniel Max & Marcandrea LLC | Optometrist | 1701 East Broad St., Ste 109, Mansfield, TX 76063 | 2019-10-09 |
| 1861046385 | Lacey Eaton | Counselor | 805 Killian Dr, Mansfield, TX 76063 | 2019-08-01 |
| Find all providers in zip 76063 | ||||
| Taxonomy Code | 261QR0401X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Definition to come... |
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| 1376016410 | Elite 360 Health and Wellness | Clinic/Center | 1409 S Lamar, Ste. 245, Dallas, TX 75215-6818 | 2019-01-10 |
| 1902333792 | Medcare Pediatric Rehab Center, Lp | Clinic/Center | 21004 Interstate 45 N, Spring, TX 77373-2917 | 2017-05-11 |
| 1023544418 | Medcare Pediatric Rehab Center, Lp | Clinic/Center | 5095 Preston Ave, Pasadena, TX 77505-2053 | 2017-05-04 |
| 1871029264 | Medcare Pediatric Rehab Center, Lp | Clinic/Center | 4818 E Sam Houston Pkwy N, Houston, TX 77015-3240 | 2017-05-04 |
| 1356793509 | Individual | Clinic/Center | 3500 Timberwood Cir Apt 2137, Arlington, TX 76015-3129 | 2016-07-11 |
| 1801242839 | Transitional Learning Center At Galveston | Clinic/Center | 4416 10th St, Lubbock, TX 79416-4800 | 2016-05-09 |
| 1225401805 | Milestones | Clinic/Center | 2704 S 26th St, Mcallen, TX 78503-7812 | 2015-11-04 |
| 1326421173 | Costa Therapy Institute, LLC | Clinic/Center | 1058 Palm Blvd, Brownsville, TX 78520-6168 | 2015-06-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.