Provider Demographics
NPI:1790974517
Name:DESTINY HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:DESTINY HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DIXON
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-522-3683
Mailing Address - Street 1:327 N QUEEN ST STE 306
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-4987
Mailing Address - Country:US
Mailing Address - Phone:252-522-3683
Mailing Address - Fax:252-522-4355
Practice Address - Street 1:327 N QUEEN ST
Practice Address - Street 2:STE. 306
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-4984
Practice Address - Country:US
Practice Address - Phone:252-521-1139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3423251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418486Medicaid
NC6601768Medicaid
NCHC3423OtherHOME CARE AGENCY