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Organization
NEW DESTINATIONS, INC.
Active
Organization
NEW DESTINATIONS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY LEE LACKEY (EXECUTIVE DIRECTOR)
(919) 414-2860
Entity
Organization
Contact information
Practice address
711 BROOKDALE DR, STATESVILLE, NC 28677-3405
(919) 414-2860
(704) 872-6766
Mailing address
5720 TURNER STORE LN, RALEIGH, NC 27603-7976
(919) 414-2860
(980) 225-0385
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL-049-121
NC
311ZA0620X
Adult Care Home Facility
MHL-049-121
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
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Other
Enumeration date
01/09/2010
Last updated
08/16/2017
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