| Destiny League | |
|
8201 Corporate Dr Ste 630 Hyattsville MD 20785-2371 | |
| (410) 213-5494 | |
| Not Available |
| Full Name | Destiny League |
|---|---|
| Speciality | Clinic/Center |
| Location | 8201 Corporate Dr Ste 630, Hyattsville, Maryland |
| Authorized Official Name and Position | Obi Herberts (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2026446886 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Destiny League 8201 Corporate Dr Ste 630 Hyattsville MD 20785-2371 Ph: (410) 213-5494 | Destiny League 8201 Corporate Dr Ste 630 Hyattsville MD 20785-2371 Ph: (410) 213-5494 |
| NPI Number | 1740900778 |
|---|---|
| Provider Enumeration Date | 08/30/2022 |
| Last Update Date | 08/30/2022 |
| Certification Date | 08/30/2022 |
| Medicare PECOS PAC ID | 0345618617 |
|---|---|
| Medicare Enrollment ID | O20221116003047 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740900778 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Chiamaka Nnah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205587284 PECOS PAC ID: 1557758315 Enrollment ID: I20221116003111 |
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