Organization
DESTINATION LIFE LLC
Active
Parent organization
DESTINATION LIFE LLC
Other names
Destination Therapy
Organization subpart
Yes
Provider details
NPI number
Legal business name
DESTINATION LIFE LLC
Authorized official
ZEMELDA D. CARR (ADM & 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
1759 BROAD PARK CIR S STE 113, MANSFIELD, TX 76063-7836
(817) 473-1312
(866) 990-2813
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7760000001
DME
TX
Enumeration date
05/18/2020
Last updated
07/30/2021
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