Organization
DESTINY RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN NDIZEYE (CFO)
(904) 731-6454
Entity
Organization
Contact information
Practice address
4030 CANNING ST, DANVILLE, IN 46122-6009
(904) 731-6454
Mailing address
4030 CANNING ST, DANVILLE, IN 46122-6009
(904) 731-6454
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/23/2026
Last updated
01/23/2026
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