Provider Demographics
NPI:1508361684
Name:NEW DESTINY YOUTH FACILITY, INC
Entity Type:Organization
Organization Name:NEW DESTINY YOUTH FACILITY, INC
Other - Org Name:NEW DESTINY YOUTH FACILITY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-330-7357
Mailing Address - Street 1:15508 GEORGES LETOUR AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-5334
Mailing Address - Country:US
Mailing Address - Phone:661-330-7357
Mailing Address - Fax:661-587-9668
Practice Address - Street 1:14 CLAUDIA AUTUMN DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93314-4768
Practice Address - Country:US
Practice Address - Phone:661-587-3194
Practice Address - Fax:661-587-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANONEOtherNONE