Provider Demographics
NPI:1740468008
Name:NEW DESTINATON LLC
Entity type:Organization
Organization Name:NEW DESTINATON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WESTLY
Authorized Official - Last Name:AVERYT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:202-546-0000
Mailing Address - Street 1:1424 PENNSYLVANIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3029
Mailing Address - Country:US
Mailing Address - Phone:202-546-0000
Mailing Address - Fax:
Practice Address - Street 1:1424 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3029
Practice Address - Country:US
Practice Address - Phone:202-546-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder