1922445428 NPI number — DAYMARK RECOVERY SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922445428 NPI number — DAYMARK RECOVERY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAYMARK RECOVERY SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922445428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
284 EXECUTIVE PARK DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-1894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-939-1133
Provider Business Mailing Address Fax Number:
704-939-1173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
284 EXECUTIVE PARK DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-1894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-939-1133
Provider Business Practice Location Address Fax Number:
704-939-1173
Provider Enumeration Date:
05/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
BILLY
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
704-939-1133

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3410027 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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