Destiny Life Center Cog
LBN: Destiny Life Center Cog
Destiny Life Center Cog is an health care organization with primary practice located at 518 E Jefferson Blvd , Fort Wayne IN 46802-3204. The organization recently has 4 registered licenses in different health care specialties including Other Service Providers / Meals, Other Service Providers / Lodging, Agencies / Community/Behavioral Health, Agencies / In Home Supportive Care. Agencies / In Home Supportive Care is the primary health care specialty.
Destiny Life Center Cog can be contacted via phone (260) 557-6183, or through Jimerson, Patricia via phone (260) 557-6183.
Contact Information
Primary practice address
518 E Jefferson Blvd
Fort Wayne IN 46802-3204
Phone: (260) 557-6183
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Meals | 174200000X | ||
| Other Service Providers / Lodging | 177F00000X | ||
| Agencies / Community/Behavioral Health | 251S00000X | ||
| Agencies / In Home Supportive Care | 253Z00000X |
Profile Details
| NPI number | 1679044960 |
|---|---|
| LBN Legal business name | Destiny Life Center Cog |
| DBA Doing business as | |
| Authorized official | Jimerson, Patricia |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | Dec 11th, 2018 |
| Last updated | Dec 11th, 2018 - about 6 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679044960 | NPPES |
| Indiana | MEDICAID | 05 | |
| Indiana | Other | 35257218 |
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