| Destiny Residential Care, Llc | |
|
15 Teri Cir Apt 82 Westbrook ME 04092-3972 | |
| (207) 317-7828 | |
| Not Available |
| Full Name | Destiny Residential Care, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 15 Teri Cir Apt 82, Westbrook, Maine |
| Authorized Official Name and Position | Anicet Bakunda (MANAGING MEMBER) |
| Authorized Official Contact | 2073177828 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Destiny Residential Care, Llc 15 Teri Cir Apt 82 Westbrook ME 04092-3972 Ph: (207) 317-7828 | Destiny Residential Care, Llc 15 Teri Cir Apt 82 Westbrook ME 04092-3972 Ph: (207) 317-7828 |
| NPI Number | 1104596493 |
|---|---|
| Provider Enumeration Date | 09/17/2021 |
| Last Update Date | 09/17/2021 |
| Certification Date | 08/27/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104596493 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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