Organization
DAYSTAR CENTER FOR SPIRITUAL RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FERN ROBERTA WILCOX LPC, CAADC (EXECUTIVE DIRECTOR)
(717) 230-9898
Entity
Organization
Contact information
Practice address
125 N. 18TH ST., HARRISBURG, PA 17103
(717) 230-9898
(717) 238-1793
Mailing address
PO BOX 60574, HARRISBURG, PA 17106
(717) 230-9898
(717) 238-1793
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
227077
PA
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018539150001
—
PA
01
—
100035
CCBH IDENTIFIER
PA
01
—
227077
DEPT OF HEALTH FACILITY
PA
Enumeration date
03/08/2007
Last updated
06/09/2015
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