Organization
DESTINATION LIFE LLC-S
Active
Parent organization
DESTINATION LIFE LLC-S
Other names
Destination Therapy, Destination Lab
Organization subpart
Yes
Provider details
NPI number
Legal business name
DESTINATION LIFE LLC-S
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
2001 SE GREEN OAKS BLVD STE 130, ARLINGTON, TX 76018-0952
(817) 473-1312
(866) 990-2813
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25D2200016
CLIA MS
MS
05
—
404951201
—
TX
01
—
45D2207166
CLIA
TX
01
—
482228
PTAN
TX
01
—
567960000
THERAPY CLINIC
TX
Enumeration date
05/18/2020
Last updated
07/30/2021
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