Organization
NEW DESTINY HEALTH LLC
Active
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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