Provider Demographics
NPI:1558622423
Name:NEW DESTINY PERSONAL HOME
Entity Type:Organization
Organization Name:NEW DESTINY PERSONAL HOME
Other - Org Name:NEW DESTINY PERSONAL CARE HOME ONE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMETT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SHERRIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-225-6068
Mailing Address - Street 1:308 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-0828
Mailing Address - Country:US
Mailing Address - Phone:912-225-6068
Mailing Address - Fax:912-225-6068
Practice Address - Street 1:308 LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30461-0828
Practice Address - Country:US
Practice Address - Phone:912-225-6068
Practice Address - Fax:912-225-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA385HR2055X385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child