Destiny Family Care Home

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL-092-759 Issued in NC

Legal business name

DESTINY FAMILY CARE HOME

Practice address

5005 Hollyridge Dr
Raleigh, NC 27612-3109

Phone

(919) 789-9811

Fax

(919) 789-9811

NPI assigned

Feb 24, 2010

Last updated

Feb 24, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Anthonia Uzoamaka Ezuma

Title

Administrator

Phone

(919) 345-4722

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266969600000",
    "number": "1063734564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5005 HOLLYRIDGE DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123109",
            "telephone_number": "919-789-9811",
            "fax_number": "919-789-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5005 HOLLYRIDGE DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123109",
            "telephone_number": "919-789-9811",
            "fax_number": "919-789-9811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY FAMILY CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-24",
        "last_updated": "2010-02-24",
        "status": "A",
        "authorized_official_last_name": "EZUMA",
        "authorized_official_first_name": "ANTHONIA",
        "authorized_official_middle_name": "UZOAMAKA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "919-345-4722",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-092-759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Design for Change
• Shannon Desmond
• Maria Despres, NP
• Kimberly Dessources
• Amy Destefano, MD
• Destiny Home, Inc. #2
• Michael Dettloff
• Donald Gene Detweiler, M.D.
• Lauren Nicole Detweiler, FNP-C
• Leana Oliver Deuel, PT

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.