DESTINATION LIFE LLC (NPI# 1114328416) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114328416 |
| Entity Type | Organization |
| Organization Name | DESTINATION LIFE LLC |
| Practice Address |
1759 Broad Park Cir S Ste 113 Mansfield TX 76063-7836 |
| Practice Telephone | 8174731312 |
| Practice Fax Number | 8669902813 |
| Mailing Telephone | 8174731312 |
| Mailing Fax Number | 8669902813 |
| Enumeration Date | 2014-09-06 |
| Last Update Date | 2020-06-03 |
| Authorized Official Name | ZEMELDA D. CARR (ADM AND AUTH REP) |
| Authorized Official Telephone | 8174731312 |
| Is Organization Subpart | Y |
| Parent Organization Name | DESTINATION LIFE LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | Nursing Service Providers | ||
| N | 251E00000X | Home Health | ========= | TX | Agencies |
| N | 253Z00000X | In Home Supportive Care | Agencies | ||
| N | 305S00000X | Point of Service | Managed Care Organizations | ||
| N | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 3747P1801X |
Technician Specialization: Personal Care Attendant |
Nursing Service Related Providers | ||
| N | 374U00000X | Home Health Aide | Nursing Service Related Providers | ||
| Y | 251E00000X | Home Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | NIP | 1114328416 | 01 |
| TX | MEDICARE PTAN | 482228 | 01 |
| TX | DME | 7760000001 | 01 |
| TX | LICENSE | 567960000 | 01 |
| TX | 365911201 | 05 | |
| TX | FACILITY LICENSE | 567960000 | 01 |
| TX | 365911202 | 05 | |
| TX | HOME HEALTHCARE | 019328 | 01 |
| TX | 4049512 | 05 | |
| TX | GROUP MEDICARE | 324611YS3B | 01 |
| Other Name | Type Code |
|---|---|
| Destination Life Therapy & Wellness | Doing Business As Name - Organization |
| SaJourney | Doing Business As Name - Organization |
| SaJourney | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629691167 | Destination Life LLC | Social Worker | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-05-19 |
| 1831712413 | Destination Life LLC | Physical Therapist | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-05-18 |
| 1588287163 | Destination Life LLC | Durable Medical Equipment & Medical Supplies | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-05-18 |
| Street Address |
1759 BROAD PARK CIR S STE 113 |
| City | MANSFIELD |
| State | TX |
| Zip Code | 76063-7836 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821699588 | My Nguyen | Registered Nurse | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-11-07 |
| 1023625894 | Sajourney Pllc | Social Worker | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-09-25 |
| 1356955884 | Amber S Lockett | Social Worker | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-09-02 |
| 1134730880 | Lauren E Moss | Social Worker | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-08-14 |
| 1275159774 | Melanie Canas | Registered Nurse | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-06-19 |
| 1891319000 | Keri Jo Coleman | Registered Nurse | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-06-03 |
| 1629691167 | Destination Life LLC | Social Worker | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-05-19 |
| 1831712413 | Destination Life LLC | Physical Therapist | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-05-18 |
| 1588287163 | Destination Life LLC | Durable Medical Equipment & Medical Supplies | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2020-05-18 |
| 1790214989 | Xaquita Wicks | Registered Nurse | 1759 Broad Park Cir S Ste 113, Mansfield, TX 76063-7836 | 2017-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316558349 | Lindsey Vandyke, D.o. Pllc | Internal Medicine | 3150 E Broad Street, Ste 100, Mansfield, TX 76063 | 2020-08-13 |
| 1942819867 | Jennifer Que Chau Nguyen | Pharmacist | 980 U.S. 287 Frontage Rd #287, Mansfield, TX 76063 | 2020-07-27 |
| 1194346890 | Ana Maria Gonzalez | Dentist | 1600 Us Highway 287, Suite 102, Mansfield, TX 76063 | 2020-05-04 |
| 1245869080 | Stateserv Medical of Texas, LLC | Durable Medical Equipment & Medical Supplies | 7941 Rodeo Trail, Mansfield, TX 76063 | 2020-04-03 |
| 1649802232 | Mary Puanani Kamai | Nurse Practitioner | 1301 E. Debbie Lane, Suite 102 #1405, Mansfield, TX 76063 | 2020-02-11 |
| 1770123028 | Gladys Vera Nfodzo | Nurse Practitioner | 901 W. Broad St, Mansfield, TX 76063 | 2020-01-14 |
| 1669011300 | Alexa Smith | Nurse Practitioner | 2800 E Broad St #304, Mansfield, TX 76063 | 2019-12-28 |
| 1477190437 | Mel Rockwall LLC | Optometrist | 1701 East Broad Street, Ste 109, Mansfield, TX 76063 | 2019-12-09 |
| 1376185512 | Daniel Max & Marcandrea LLC | Optometrist | 1701 East Broad St., Ste 109, Mansfield, TX 76063 | 2019-10-09 |
| 1861046385 | Lacey Eaton | Counselor | 805 Killian Dr, Mansfield, TX 76063 | 2019-08-01 |
| Find all providers in zip 76063 | ||||
| Taxonomy Code | 251E00000X |
| Grouping | Agencies |
| Classification | Home Health |
| A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. |
| Notes: Source: CFR42 Chapter IV Part 484, http://www.access.gpo.gov/nara/cfr/waisidx_99/42cfr484_99.html [7/1/2007: definition added, source added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083214381 | Infinite Care Health Services LLC | Home Health | 288 Glessner Ave Ste B, Mansfield, OH 44903-2225 | 2020-10-27 |
| 1992338230 | Carrington Healthcare Services, Inc | Home Health | 2755 Lexington Ave Apt 12a, Mansfield, OH 44904-1460 | 2020-02-14 |
| 1861042202 | Angels On Board Medical Transportation, LLC | Home Health | 604 Bogey Ln, Mansfield, TX 76063-5451 | 2019-09-18 |
| 1760039804 | Leeann Neumann | Home Health | 1035 Sunset Blvd, Mansfield, OH 44907-2334 | 2019-08-22 |
| 1831755172 | Nationwide Home Health Care, LLC | Home Health | 1 Marion Ave Ste 309, Mansfield, OH 44903-7907 | 2019-05-13 |
| 1982190427 | Salvation Care | Home Health | 155 W 4th St Apt B, Mansfield, OH 44903-1671 | 2018-07-09 |
| 1730681594 | Alliance Home Health Service, LLC | Home Health | 787 Lexington Ave Ste 305, Mansfield, OH 44907-1998 | 2018-03-07 |
| 1760995716 | Care Focus Home Health Care Inc | Home Health | 4505 Catherine Dr, Mansfield, TX 76063-2397 | 2017-11-13 |
| 1336680842 | Loving Hearts Home Health | Home Health | 54 Sturges Ave, Mansfield, OH 44902-1912 | 2017-03-16 |
| 1275085607 | New Direction Home Healthcare of Dfw Inc | Home Health | 1015 E Dallas St, Ste 2, Mansfield, TX 76063-2000 | 2016-11-02 |
| Find all providers in MANSFIELD | ||||
Please comment or provide details below to improve the information on DESTINATION LIFE LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.