Provider Demographics
NPI:1245081025
Name:DESTINY CENTER FOR RECOVERY
Entity type:Organization
Organization Name:DESTINY CENTER FOR RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLZEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:614-327-8337
Mailing Address - Street 1:1350 FORSYTH CT
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-9701
Mailing Address - Country:US
Mailing Address - Phone:614-498-0087
Mailing Address - Fax:
Practice Address - Street 1:3992 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-2364
Practice Address - Country:US
Practice Address - Phone:614-498-0078
Practice Address - Fax:614-498-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty