Basic Information
| Provider Information | |||||||||
| NPI: | 1376899104 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW DESTINATIONS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5720 TURNER STORE LN | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276037976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197732706 | ||||||||
| FaxNumber: | 9802250385 | ||||||||
| Practice Location | |||||||||
| Address1: | 124 OAKPARK DR UNIT J | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281157884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046580220 | ||||||||
| FaxNumber: | 7046580223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2012 | ||||||||
| LastUpdateDate: | 10/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | LACKEY | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9197732706 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3104A0625X | N | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness | 311ZA0620X | N | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.