NPIMap

Organization Active NPI

Destiny Hospice Care, Inc

  • Community Based Hospice Care Agency
  • Moreno Valley, CA
National Provider Identifier
1194027672
Registry record updated Apr 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
DESTINY HOSPICE CARE, INC
Practice address
12364 Perris Blvd
Moreno Valley, CA 92557-7423
Phone
(951) 242-4288
NPI assigned
Dec 3, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2019

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

Authorized official

Name
Udoekpo N Ekpo
Title
President
Phone
(951) 243-8871

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

12364 Perris Blvd
Moreno Valley, CA 92557-7423

Mailing address

PO Box 1000
Moreno Valley, CA 92556-1000
Phone (951) 243-8871

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111115000399 CA Part A Provider - Hospice 1557535267 Practice locations: Moreno Valley, CA

Hospice certification: CCN 551670

Legal name
DESTINY HOSPICE CARE, INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 1, 2012
Last certification
Jul 30, 2018
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Oct 1, 2010 in CA
Enrollment address
12364 Perris Blvd
Moreno Valley, CA 92557-7423

Care Compare: Hospice

Medicare Care Compare
Listed as
Destiny Hospice Care IncCCN 551670
Ownership
For-Profit
Certified
Jun 1, 2012
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2035866Destiny Hospice Care, Inc.12364 Perris Blvd., Moreno Valley, CA 92557Certificate of waiverJan 25, 2028

National Provider Directory

National Provider Directory

Locations

12364 Perris Blvd
Moreno Valley, CA 92557
Phone (605) 209-6421

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Udoekpo N Ekpo Individual 5% Or Greater Direct Ownership Interest Oct 18, 2010 50%
Joy N Ekpo Individual 5% Or Greater Direct Ownership InterestOwner Oct 18, 2010 50%
Corporate DirectorAdministrator Oct 1, 2016
W-2 Managing EmployeeAdministrator Oct 18, 2010 50%
Sarah Gower Individual Corporate DirectorAdministrator Oct 1, 2016

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 17

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1291334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554249600000",
    "number": "1194027672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925561000",
            "telephone_number": "951-243-8871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12364 PERRIS BLVD",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925577423",
            "telephone_number": "951-242-4288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY HOSPICE CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-03",
        "last_updated": "2019-04-03",
        "status": "A",
        "authorized_official_last_name": "EKPO",
        "authorized_official_first_name": "UDOEKPO",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-243-8871"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

Verify at the official NPI Registry.