Provider Demographics
NPI:1346481348
Name:DAYSTAR HEALTH SERVICES
Entity Type:Organization
Organization Name:DAYSTAR HEALTH SERVICES
Other - Org Name:NO
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-453-0103
Mailing Address - Street 1:1500 N MARKET ST STE C112
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-6546
Mailing Address - Country:US
Mailing Address - Phone:318-453-0103
Mailing Address - Fax:
Practice Address - Street 1:1500 N MARKET ST STE C112
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6546
Practice Address - Country:US
Practice Address - Phone:318-453-0103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA115173253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care