Provider Demographics
NPI:1194390252
Name:DESTINY BEHAVIORAL HEALTH RESIDENTIAL CARE, LLC
Entity type:Organization
Organization Name:DESTINY BEHAVIORAL HEALTH RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FUNSO
Authorized Official - Middle Name:FEYI
Authorized Official - Last Name:OGUNLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-384-8820
Mailing Address - Street 1:2911 S 87TH DR # A
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-8650
Mailing Address - Country:US
Mailing Address - Phone:602-384-8820
Mailing Address - Fax:877-288-1996
Practice Address - Street 1:10323 W ODEUM LN
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-4195
Practice Address - Country:US
Practice Address - Phone:623-440-4126
Practice Address - Fax:877-288-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness