Organization
DESTINY'S FULFILLED L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS STACEY MICHELLE COOK (CHIEF EXECTUIVE OFFICER)
(804) 276-1702
Entity
Organization
Contact information
Practice address
1908 CHEVELLE DR, RICHMOND, VA 23235-5641
(804) 276-1702
(804) 276-6051
Mailing address
PO BOX 74924, RICHMOND, VA 23236-0016
(804) 276-1702
(804) 276-6051
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
320-2006
VA
Other
Enumeration date
03/14/2006
Last updated
08/22/2020
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