Organization
DESTINATION LIFE LLC
Active
Parent organization
DESTINATION LIFE LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DESTINATION LIFE LLC
Authorized official
ZEMELDA D. CARR (ADM AND AUTH REP)
(817) 473-1312
Entity
Organization
Contact information
Practice address
2001 SE GREEN OAKS BLVD STE 130, ARLINGTON, TX 76018-0952
(817) 473-1312
(866) 990-2813
Mailing address
2001 SE GREEN OAKS BLVD STE 130, ARLINGTON, TX 76018-0952
(817) 473-1312
(866) 990-2813
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
251E00000X
Home Health Agency
—
TX
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
305S00000X
Point of Service
—
—
314000000X
Skilled Nursing Facility
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3747P1801X
Personal Care Attendant
—
—
374U00000X
Home Health Aide
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114328416
NIP
TX
01
—
324611YS3B
GROUP MEDICARE
TX
05
—
365911201
—
TX
05
—
365911202
—
TX
05
—
4049512
—
TX
05
—
404951202
—
TX
01
—
482228
MEDICARE PTAN
TX
01
—
567960000
FACILITY LICENSE
TX
01
—
7760000001
DME
TX
Enumeration date
09/06/2014
Last updated
07/21/2022
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