NPIMap

Organization Active NPI

Destiny Behavioral Health Residential Care, LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Tolleson, AZ
National Provider Identifier
1336405778
Registry record updated Apr 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
BH4023 Issued in AZ
Legal business name
DESTINY BEHAVIORAL HEALTH RESIDENTIAL CARE, LLC
Practice address
2911 S 87TH Dr
Tolleson, AZ 85353-8650
Phone
(623) 435-6566
Fax
(623) 435-6566
NPI assigned
Apr 10, 2012
Last updated
Apr 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2012

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) 435-6566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X BH4023 AZ Primary

Addresses

Primary practice location

2911 S 87TH Dr
Tolleson, AZ 85353-8650

Mailing address

2911 S 87TH Dr
Tolleson, AZ 85353-8650
Phone (623) 435-6566

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": "1334016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334016000000",
    "number": "1336405778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 S 87TH DR",
            "city": "TOLLESON",
            "state": "AZ",
            "postal_code": "853538650",
            "telephone_number": "623-435-6566",
            "fax_number": "623-435-6566"
        },
        {
            "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",
            "fax_number": "623-435-6566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY BEHAVIORAL HEALTH RESIDENTIAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-10",
        "last_updated": "2012-04-10",
        "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": "623-435-6566",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH4023",
            "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 Apr 10, 2012; 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.