Provider Demographics
NPI:1124353032
Name:DESTIN YOUTH & TRANSITIONAL CARE INC.
Entity type:Organization
Organization Name:DESTIN YOUTH & TRANSITIONAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:THOMPSON-COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-723-9676
Mailing Address - Street 1:5819 CANDLELIGHT LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8591
Mailing Address - Country:US
Mailing Address - Phone:817-723-9676
Mailing Address - Fax:
Practice Address - Street 1:5819 CANDLELIGHT LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8591
Practice Address - Country:US
Practice Address - Phone:817-723-9676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services