Provider Demographics
NPI:1194337006
Name:HOUSE OF DESTINY
Entity type:Organization
Organization Name:HOUSE OF DESTINY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VENABLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:252-432-5970
Mailing Address - Street 1:402 W BELLE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-4101
Mailing Address - Country:US
Mailing Address - Phone:252-432-5970
Mailing Address - Fax:252-572-4489
Practice Address - Street 1:1009 HARRIETT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5527
Practice Address - Country:US
Practice Address - Phone:252-432-5970
Practice Address - Fax:252-572-4489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness