Organization
DAYSTAR RESIDENTIAL GROUP HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DENISE DAVIS (OWNER/ OPERATOR)
(252) 977-1210
Entity
Organization
Contact information
Practice address
418 MAGNOLIA DR, ROCKY MOUNT, NC 27801-5843
(252) 977-1210
(252) 446-5768
Mailing address
418 MAGNOLIA DR, ROCKY MOUNT, NC 27801-5843
(252) 977-1210
(252) 446-5768
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-033-056
NC
Other
Enumeration date
05/07/2008
Last updated
05/07/2008
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