Provider Demographics
NPI:1457883779
Name:DESTINATIONS WELLNESS, LLC.
Entity type:Organization
Organization Name:DESTINATIONS WELLNESS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:TAMPOSI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:603-325-0954
Mailing Address - Street 1:33 MAIN ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-2776
Mailing Address - Country:US
Mailing Address - Phone:603-943-5622
Mailing Address - Fax:603-943-5803
Practice Address - Street 1:33 MAIN ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-2776
Practice Address - Country:US
Practice Address - Phone:603-943-5622
Practice Address - Fax:603-943-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH707261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder