NPIMap

Organization Active NPI

Destination Life LLC-S

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Arlington, TX
National Provider Identifier
1831712413
Registry record updated Jul 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
DESTINATION LIFE LLC-S
Practice address
2001 SE Green Oaks Blvd Ste 130
Arlington, TX 76018-0952
Phone
(817) 473-1312
Fax
(866) 990-2813
NPI assigned
May 18, 2020
Organization subpart
Yes
Parent organization
DESTINATION LIFE LLC-SAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 30, 2021

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

Authorized official

Name
Zemelda D. Carr
Title
Adm & Auth Rep
Phone
(817) 473-1312

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X
Developmental Disabilities Clinic/Center 261QD1600X
Hearing and Speech Clinic/Center 261QH0700X
Multi-Specialty Clinic/Center 261QM1300X
Rehabilitation Clinic/Center 261QR0400X
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X Primary
Clinical Medical Laboratory 291U00000X
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X

Addresses

Primary practice location

2001 SE Green Oaks Blvd Ste 130
Arlington, TX 76018-0952

Mailing address

2001 SE Green Oaks Blvd Ste 130
Arlington, TX 76018-0952
Phone (817) 473-1312

Other practice location 1

1759 Broad Park Cir S Ste 113
Mansfield, TX 76063-7836
Phone (817) 473-1312

Other identifiers 5

IdentifierTypeStateIssuer
45D2207166OtherTXCLIA
482228OtherTXPTAN
404951201MedicaidTX
25D2200016OtherMSCLIA MS
567960000OtherTXTHERAPY CLINIC

Other names 2

  • Destination Therapy Doing business as
  • Destination Lab Other name

National Provider Directory

National Provider Directory
Part of
Destination Life LLC-S

Locations

1804 Owen Ct
Ste 110
Mansfield, TX 76063
Phone (817) 473-1312

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1589760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627603200000",
    "number": "1831712413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 SE GREEN OAKS BLVD STE 130",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760180952",
            "telephone_number": "817-473-1312",
            "fax_number": "866-990-2813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 SE GREEN OAKS BLVD STE 130",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760180952",
            "telephone_number": "817-473-1312",
            "fax_number": "866-990-2813"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1759 Broad Park Cir S Ste 113",
            "address_purpose": "LOCATION",
            "city": "Mansfield",
            "state": "TX",
            "postal_code": "760637836",
            "country_code": "US",
            "telephone_number": "817-473-1312",
            "fax_number": "866-990-2813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DESTINATION LIFE LLC-S",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DESTINATION LIFE LLC-S",
        "enumeration_date": "2020-05-18",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A",
        "authorized_official_last_name": "CARR",
        "authorized_official_first_name": "ZEMELDA",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "ADM & AUTH REP",
        "authorized_official_telephone_number": "817-473-1312"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D2207166",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "482228",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404951201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA MS",
            "identifier": "25D2200016",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THERAPY CLINIC",
            "identifier": "567960000",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Destination Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Destination Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Destination Lab",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Arlington, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; 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.