# DESTINATION LIFE LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DESTINATION LIFE LLC
- **Other names:** Destination Therapy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1588287163
- **Legal business name:** DESTINATION LIFE LLC
- **Authorized official:** ZEMELDA D. CARR (ADM & AUTH REP)
- **Authorized official phone:** (817) 473-1312

## Contact information

- **Practice address:** 2001 SE GREEN OAKS BLVD STE 130, ARLINGTON, TX 76018-0952
- **Practice address phone:** (817) 473-1312
- **Practice address fax:** (866) 990-2813
- **Mailing address:** 1759 BROAD PARK CIR S STE 113, MANSFIELD, TX 76063-7836
- **Mailing address phone:** (817) 473-1312
- **Mailing address fax:** (866) 990-2813

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 05/18/2020
- **Last updated:** 07/30/2021