Provider Demographics
NPI:1427381755
Name:DAYSTAR ADULT DAY PROGRAM, LLC
Entity Type:Organization
Organization Name:DAYSTAR ADULT DAY PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONACA
Authorized Official - Middle Name:MAYE
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:336-273-2110
Mailing Address - Street 1:PO BOX 16184
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27416-0184
Mailing Address - Country:US
Mailing Address - Phone:336-273-2110
Mailing Address - Fax:336-273-2114
Practice Address - Street 1:415 N EDGEWORTH ST STE 209
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2071
Practice Address - Country:US
Practice Address - Phone:336-273-2110
Practice Address - Fax:336-273-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services