Organization
NEW DESTINY HEALTH LLC
Active
Other names
New Destiny Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF BOLANOS MD (MEMBER-MANAGER)
(480) 522-0566
Entity
Organization
Contact information
Practice address
1072 E DRAGON FLY RD, QUEEN CREEK, AZ 85143
(480) 522-0566
Mailing address
530 E HUNT HWY, SUITE 103-188, SAN TAN VALLEY, AZ 85143
(480) 522-0566
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
12/08/2019
Last updated
12/07/2020
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