Provider Demographics
NPI:1316831282
Name:DESTINY'S HAVEN, LLC
Entity type:Organization
Organization Name:DESTINY'S HAVEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:COLIN
Authorized Official - Last Name:PRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-651-1317
Mailing Address - Street 1:6736 PATTONSBURG DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-2152
Mailing Address - Country:US
Mailing Address - Phone:980-949-8686
Mailing Address - Fax:
Practice Address - Street 1:6736 PATTONSBURG DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-2152
Practice Address - Country:US
Practice Address - Phone:980-949-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children