# DAYSTAR RESIDENTIAL GROUP HOME INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811163017
- **Authorized official:** MRS. DENISE DAVIS (OWNER/ OPERATOR)
- **Authorized official phone:** (252) 977-1210

## Contact information

- **Practice address:** 418 MAGNOLIA DR, ROCKY MOUNT, NC 27801-5843
- **Practice address phone:** (252) 977-1210
- **Practice address fax:** (252) 446-5768
- **Mailing address:** 418 MAGNOLIA DR, ROCKY MOUNT, NC 27801-5843
- **Mailing address phone:** (252) 977-1210
- **Mailing address fax:** (252) 446-5768

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-033-056 | NC | Yes |

## Other

- **Enumeration date:** 05/07/2008
- **Last updated:** 05/07/2008