Destiny Recovery Center Iop

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

License

300377AP Issued in CA

Legal business name

DESTINY RECOVERY CENTER IOP

Practice address

23041 Avenida de la Carlota Ste 280
Laguna Hills, CA 92653-1531

Phone

(877) 706-2650

NPI assigned

Sep 17, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Mordechai Rubin

Title

Owner

Phone

(877) 706-2650

Specialties & licenses 1

Addresses

Other names 1

• DETINY RECOVERY CENTER IOP Doing business as

Locations

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

{
    "created_epoch": "1505606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505606400000",
    "number": "1356860738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23041 AVENIDA DE LA CARLOTA STE 280",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926531531",
            "telephone_number": "877-706-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23041 AVENIDA DE LA CARLOTA STE 280",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926531531",
            "telephone_number": "877-706-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY RECOVERY CENTER IOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-17",
        "last_updated": "2017-09-17",
        "status": "A",
        "authorized_official_last_name": "RUBIN",
        "authorized_official_first_name": "MORDECHAI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "877-706-2650",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "CA",
            "license": "300377AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DETINY RECOVERY CENTER IOP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristin Dennis, HIS
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• Prithvi S Dhani, DDS
• Kimvir S Dhillon, MD
• Priyal Pragnesh Dholakiya, MD

• Comprehensive Outpatient Rehabilitation Facility (CORF) in Laguna Hills, CA
• Providers in Laguna Hills, CA by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2017; 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.