Destination Vitality LTD

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

DESTINATION VITALITY LTD

Practice address

310 Sunrise Ave Ste B
Honesdale, PA 18431-1032

Phone

(570) 801-9488

Fax

(877) 675-2576

NPI assigned

Mar 3, 2022

Last updated

Oct 31, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dana Gallik, CRNPNPI 1548807340

Title

Owner

Phone

(570) 637-1028

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dana Marie Gallik, CRNP

  • Family Nurse Practitioner
  • Beach Lake, PA
  • NPI 1548807340
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1646265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1689321382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 MY WAY LN",
            "city": "BEACH LAKE",
            "state": "PA",
            "postal_code": "184053111",
            "telephone_number": "570-637-1028",
            "fax_number": "877-675-2576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 SUNRISE AVE STE B",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184311032",
            "telephone_number": "570-801-9488",
            "fax_number": "877-675-2576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINATION VITALITY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-03",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "GALLIK",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-637-1028",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Optimantra",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "310 Sunrise Ave Ste B",
            "city": "Honesdale",
            "state": "PA",
            "country_code": "US",
            "postal_code": "184311032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael Burke Delage Jr., MD
• Tammy Sue Deleo, PMHNP-BC, MSN, RN
• Wendy Delisi, LCSW
• Carrie Elizabeth Demers M.D., M.D.
• Marla Osborne Dempsey, D.O.
• Luisa Fernanda Devia, MD
• William Russell Dewar III, MD
• Diakon Lutheran Social Ministries (Diakon Home Health)
• Paul M Diamond, M.D.
• Carly Dietz, NCC, MS

• Health Service Clinic/Center in Honesdale, PA
• Providers in Honesdale, PA by specialty
• Health Service Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.