Destiny'S Fulfilled L.L.C.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

320-2006 Issued in VA

Legal business name

DESTINY'S FULFILLED L.L.C.

Practice address

1908 Chevelle Dr
Richmond, VA 23235-5641

Phone

(804) 276-1702

Fax

(804) 276-6051

NPI assigned

Mar 14, 2006

Organization subpart

No

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

Authorized official

Name

Miss Stacey Michelle Cook

Title

Chief Exectuive Officer

Phone

(804) 276-1702

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891764882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74924",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232360016",
            "telephone_number": "804-276-1702",
            "fax_number": "804-276-6051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1908 CHEVELLE DR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232355641",
            "telephone_number": "804-276-1702",
            "fax_number": "804-276-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY'S FULFILLED L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "CHIEF EXECTUIVE OFFICER",
        "authorized_official_telephone_number": "804-276-1702",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "320-2006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Deska
• John Simmons Desmarais
• Lauren Elizabeth Desroches, PA
• Emmanuel N Dessypris, M.D
• Destiny'S Fulfilled Inc
• Catherine A Deteresa, MD
• Charity Deters
• Caroline Detorie
• Alicia B Dettmer, D.P.T
• Brittany Deutch

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Richmond, VA
• Providers in Richmond, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.