DESTINY HOMES OF PHYD, INC. (PHYD, INC. (PRETTY HOMES YOUTH DEVELOPMENT)) NPI 1003005240
Residential Treatment Facility, Emotionally Disturbed Children in Raleigh, NC
About DESTINY HOMES OF PHYD, INC. (PHYD, INC. (PRETTY HOMES YOUTH DEVELOPMENT))
Destiny Homes Of Phyd, Inc. (phyd, Inc. (pretty Homes Youth Development)) is a provider established in Raleigh, North Carolina specializing in residential treatment facility, emotionally disturbed children. The NPI number of Destiny Homes Of Phyd, Inc. (phyd, Inc. (pretty Homes Youth Development)) is 1003005240 and was assigned on October 2007. The practitioner's primary taxonomy code is 322D00000X with license number MHL-092-537 (NC). The provider is registered as an organization and their NPI record was last updated 13 years ago. The provider's is doing business as Destiny Homes Of Phyd, Inc.. The authorized official of this NPI record is Mrs. Andrea Pretty (President)
| NPI | 1003005240 |
| Provider Name | DESTINY HOMES OF PHYD, INC. (PHYD, INC. (PRETTY HOMES YOUTH DEVELOPMENT)) |
| Provider Location Address | 1611 POOLE RD RALEIGH, NC 27610 |
| Provider Mailing Address | PO BOX 20181 RALEIGH, NC 27619 |
| NPI Entity Type | Organization |
| Is Sole Proprietor? | N/A |
| Is Organization Subpart? | No |
| Other Organization Name | DESTINY HOMES OF PHYD, INC. |
| Other Name Type | Doing Business As (3) |
| Enumeration Date | 10-23-2007 |
| Last Update Date | 03-26-2009 |
Primary Taxonomy
| Taxonomy Code | 322D00000X |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| Type | Residential Treatment Facilities |
| License No. | MHL-092-537 |
| License State | NC |
| Taxonomy Description | A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. |
Business Address
DESTINY HOMES OF PHYD, INC.
1611 POOLE RD
RALEIGH, NC
ZIP 27610
Phone: (919) 713-0035
Fax: (919) 713-0034
Mailing Address
DESTINY HOMES OF PHYD, INC.
PO BOX 20181
RALEIGH, NC
ZIP 27619
Phone: (919) 633-7800
Fax: (919) 713-0034
Secondary Taxonomies
The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.
| No. | Taxonomy Code | Type | Classification | Specialization | License No. | State | Primary |
|---|---|---|---|---|---|---|---|
| 1 | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | MHL-092-491 | NC | No | |
Taxonomy Description: a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. | |||||||
Additional Identifiers
Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State |
|---|---|---|
| 6603862 | MEDICAID (05) | NC |
| 6604280 | MEDICAID (05) | NC |
NPI Footnotes
What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.
Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date
The date that a NPI record was last updated or changed.
Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.