1780024844 NPI number — NEW DESTINATIONS, INC

Table of content: (NPI 1780024844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780024844 NPI number — NEW DESTINATIONS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW DESTINATIONS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780024844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5720 TURNER STORE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27603-7976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-773-2706
Provider Business Mailing Address Fax Number:
980-225-0385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1132 CAMDEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28306-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-773-2706
Provider Business Practice Location Address Fax Number:
980-225-0385
Provider Enumeration Date:
07/03/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LACKEY
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
919-773-2706

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3104A0625X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)