Healthcare Provider Details

I. General information

NPI: 1114132164
Provider Name (Legal Business Name): DESTINATION HOPE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 CEDAR LANDING RD
WINDSOR NC
27983-9012
US

IV. Provider business mailing address

PO BOX 231
WINDSOR NC
27983-0231
US

V. Phone/Fax

Practice location:
  • Phone: 917-771-9673
  • Fax:
Mailing address:
  • Phone: 917-771-9673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number008-036
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL MONIQUE SABLON
Title or Position: FACILITY DIRECTOR
Credential: BA, MA
Phone: 252-325-4673