Provider Demographics
NPI:1992261663
Name:DESTINATION HOPE, INC.
Entity type:Organization
Organization Name:DESTINATION HOPE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISDOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-771-2091
Mailing Address - Street 1:6555 NW 9TH AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2048
Mailing Address - Country:US
Mailing Address - Phone:954-771-2091
Mailing Address - Fax:954-771-2098
Practice Address - Street 1:6555 NW 9TH AVE STE 311
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2050
Practice Address - Country:US
Practice Address - Phone:954-771-2091
Practice Address - Fax:954-771-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)