Provider Demographics
NPI:1245371939
Name:DESTINY HOME, INC.
Entity type:Organization
Organization Name:DESTINY HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OSWALD
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-454-7725
Mailing Address - Street 1:1708 VINTAGE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3187
Mailing Address - Country:US
Mailing Address - Phone:919-454-7725
Mailing Address - Fax:919-231-3736
Practice Address - Street 1:630 RIPPLING STREAM RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1233
Practice Address - Country:US
Practice Address - Phone:919-454-7725
Practice Address - Fax:919-231-3736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-032-389261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health