Provider Demographics
NPI:1962384313
Name:DESTINED FOR OPTIONS - SHREVEPORT
Entity type:Organization
Organization Name:DESTINED FOR OPTIONS - SHREVEPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MC
Authorized Official - Phone:504-309-0259
Mailing Address - Street 1:610 MARSHALL ST STE 521
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3650
Mailing Address - Country:US
Mailing Address - Phone:504-715-1182
Mailing Address - Fax:504-309-2702
Practice Address - Street 1:610 MARSHALL ST STE 521
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3650
Practice Address - Country:US
Practice Address - Phone:504-715-1182
Practice Address - Fax:504-309-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care