MEDICARE: NEW DESTINATIONS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3104A0625X	Assisted Living Facility (Mental Illness)
2	311ZA0620X	Adult Care Home Facility
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1780024844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW DESTINATIONS, INC

Provider Business Mailing Address
First Line	:	5720 TURNER STORE LN
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-7976
Country	:	US
Telephone Number	:	919-773-2706
Fax Number	:	980-225-0385

Provider Business Practice Location Address
First Line	:	1132 CAMDEN RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-1848
Country	:	US
Telephone Number	:	919-773-2706
Fax Number	:	980-225-0385

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MR. LARRY LEE LACKEY
Credential	:
Telephone Number	:	919-773-2706

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	06/21/2017

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