Provider Demographics
NPI:1164228904
Name:DESTINY RECOVERY CENTER, INC.
Entity type:Organization
Organization Name:DESTINY RECOVERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:AS,BA
Authorized Official - Phone:580-798-4421
Mailing Address - Street 1:1004 REPUBLIC ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4555
Mailing Address - Country:US
Mailing Address - Phone:580-798-4421
Mailing Address - Fax:
Practice Address - Street 1:1004 REPUBLIC ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-4555
Practice Address - Country:US
Practice Address - Phone:580-798-4421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility