Basic Information
| Provider Information | |||||||||
| NPI: | 1831429174 | ||||||||
| 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: | 9194142860 | ||||||||
| FaxNumber: | 9802250385 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 BROOKDALE DR | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286773405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194142860 | ||||||||
| FaxNumber: | 7048726766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2010 | ||||||||
| LastUpdateDate: | 08/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | LACKEY | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9194142860 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | MHL-049-121 | NC | N | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 251S00000X | MHL-049-121 | NC | Y | Agencies | Community/Behavioral Health |
No ID Information.