NPIMap

Organization Active NPI

Destiny Behavioral Health Residential Care LLC 2

  • Mental Illness Community Based Residential Treatment Facility
  • Tolleson, AZ
National Provider Identifier
1093117384
Registry record updated Sep 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
BH4488 Issued in AZ
Legal business name
DESTINY BEHAVIORAL HEALTH RESIDENTIAL CARE LLC 2
Practice address
2911 S 87TH Dr
Tolleson, AZ 85353-8650
Phone
(623) 435-6566
NPI assigned
Sep 18, 2014
Last updated
Sep 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Funso Feyi Ogunla
Title
Program Director
Phone
(623) 374-3377

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X BH4488 AZ Primary

Addresses

Primary practice location

2911 S 87TH Dr
Tolleson, AZ 85353-8650

Mailing address

8824 W Preston LN
Tolleson, AZ 85353-6993

National Provider Directory

National Provider Directory
Tax ID family
Destiny Behavioral Health Residential Care LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410998400000",
    "number": "1093117384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8824 W PRESTON LN",
            "city": "TOLLESON",
            "state": "AZ",
            "postal_code": "853536993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 S 87TH DR",
            "city": "TOLLESON",
            "state": "AZ",
            "postal_code": "853538650",
            "telephone_number": "623-435-6566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY BEHAVIORAL HEALTH RESIDENTIAL CARE LLC 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-18",
        "last_updated": "2014-09-18",
        "status": "A",
        "authorized_official_last_name": "OGUNLA",
        "authorized_official_first_name": "FUNSO",
        "authorized_official_middle_name": "FEYI",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "623-374-3377",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH4488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tolleson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.