Organization
DESTINY FAMILY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANTHONIA UZOAMAKA EZUMA (ADMINISTRATOR)
(919) 345-4722
Entity
Organization
Contact information
Practice address
5005 HOLLYRIDGE DR, RALEIGH, NC 27612-3109
(919) 789-9811
(919) 789-9811
Mailing address
5005 HOLLYRIDGE DR, RALEIGH, NC 27612-3109
(919) 789-9811
(919) 789-9811
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-092-759
NC
Other
Enumeration date
02/24/2010
Last updated
02/24/2010
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