Provider Demographics
NPI:1154450583
Name:DAISY'S WAY LLC
Entity Type:Organization
Organization Name:DAISY'S WAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DANIELLE WILDER
Authorized Official - Last Name:JACKO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-215-1215
Mailing Address - Street 1:323 CLIFTON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5053
Mailing Address - Country:US
Mailing Address - Phone:252-215-1215
Mailing Address - Fax:252-215-1214
Practice Address - Street 1:323 CLIFTON ST STE 4
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5053
Practice Address - Country:US
Practice Address - Phone:252-215-1215
Practice Address - Fax:252-215-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health