New Destiny Health Services, LLC

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

Legal business name

NEW DESTINY HEALTH SERVICES, LLC

Practice address

4801 Liberty Heights Ave
Gwynn Oak, MD 21207-7157

Phone

(410) 733-4636

NPI assigned

Aug 12, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Tracy Renna Thomas

Title

Credentialing Specialist

Phone

(410) 663-4036

Specialties & licenses 1

Addresses

Tax ID family

New Destiny Health Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• New Destiny Health Services LLC

  • Addiction Medicine (Family Medicine) Physician
  • Pikesville, MD
  • NPI 1528770435
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Starlene Delores McKelvin, CRNP

  • Family Nurse Practitioner
  • Baltimore, MD
  • NPI 1548592926
  NPD (past)

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

{
    "created_epoch": "1628726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628726400000",
    "number": "1336814300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9123 SUNSET RIDGE RD",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211333651",
            "telephone_number": "410-733-4636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 LIBERTY HEIGHTS AVE",
            "city": "GWYNN OAK",
            "state": "MD",
            "postal_code": "212077157",
            "telephone_number": "410-733-4636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW DESTINY HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-12",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-12",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "RENNA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "410-663-4036",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Christian Oglesby
• Damilola Bolanle Ogunyanwo, NP

• Addiction Medicine (Family Medicine) Physician in Gwynn Oak, MD
• Providers in Gwynn Oak, MD by specialty
• Addiction Medicine (Family Medicine) Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2021; 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.