NPIMap

Organization Active NPI

Destiny Home Health Agency Inc

  • Home Health Agency
  • Moreno Valley, CA
National Provider Identifier
1750484085
Registry record updated Apr 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
250000800 Issued in CA
Legal business name
DESTINY HOME HEALTH AGENCY INC
Practice address
12981 Perris Blvd,
Suite 214
Moreno Valley, CA 92553-4112
Phone
(951) 242-1365
Fax
(951) 242-1387
NPI assigned
Sep 5, 2006
Last updated
Apr 3, 2019By the provider in NPPES
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
Joy Nsemeke Ekpo
Title
Administrator
Phone
(951) 242-1365

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 250000800 CA Primary

Addresses

Primary practice location

12981 Perris Blvd,
Suite 214
Moreno Valley, CA 92553-4112

Mailing address

PO Box 1000
Moreno Valley, CA 92556-1000
Phone (951) 242-1365

Other identifiers 2

IdentifierTypeStateIssuer
HHA08263FMedicaidCA
1750484085MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040225001288 CA Part A Provider - Home Health Agency 0345136313 Practice locations: Moreno Valley, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750484085. Details of each certification follow.

Home health agency certification: CCN 058263

Legal name
DESTINY HOME HEALTH AGENCY INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 17, 2004
Last certification
Dec 8, 2020
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Nov 23, 2003 in CA
Enrollment address
12370 Perris Blvd
Moreno Valley, CA 92557-7423
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Destiny Home Health Agency, IncCCN 058263 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Jun 17, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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
05D1021349Destiny Home Health Agency Inc12370 Perris Blvd, Moreno Valley, CA 92557Certificate of waiverJan 20, 2028

National Provider Directory

National Provider Directory

Locations

12370 Perris Blvd
Moreno Valley, CA 92557
Phone (951) 242-1365

12981 Perris Blvd
Ste 214
Moreno Valley, CA 92553
Phone (909) 242-1365

Ownership & related parties

All disclosed owners & managing parties 6

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 Corporate DirectorBoard Member Jul 1, 2013
W-2 Managing EmployeeBoard Member Jun 4, 2012
Joy N Ekpo Individual 5% Or Greater Direct Ownership Interest Dec 2, 2003 100%
Corporate DirectorBoard Member Dec 2, 2003 100%
W-2 Managing EmployeeCeo Dec 2, 2003 100%
Hadia Ashraf Individual OtherMedical Director Jul 11, 2011
Sarah Gower Individual Corporate OfficerExecutive Administrator Mar 9, 2023
Aggie U Ekpo Individual Corporate OfficerSecretary Mar 7, 2017
W-2 Managing EmployeeSecretary Mar 15, 2012
Omolola Racheal Oladosu Individual Corporate OfficerAssistant Director of Nursing Mar 1, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554249600000",
    "number": "1750484085",
    "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": "951-242-1365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12981 PERRIS BLVD,",
            "address_2": "SUITE 214",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925534112",
            "telephone_number": "951-242-1365",
            "fax_number": "951-242-1387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY HOME HEALTH AGENCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2019-04-03",
        "status": "A",
        "authorized_official_last_name": "EKPO",
        "authorized_official_first_name": "JOY",
        "authorized_official_middle_name": "NSEMEKE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "951-242-1365"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "250000800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA08263F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750484085",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

Verify at the official NPI Registry.