Provider Demographics
NPI:1437204690
Name:DAYMARK RECOVERY SERVICES, INC
Entity Type:Organization
Organization Name:DAYMARK RECOVERY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEST
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-939-1100
Mailing Address - Street 1:284 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1894
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:741 SPAINHOUR RD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9393
Practice Address - Country:US
Practice Address - Phone:336-729-0096
Practice Address - Fax:336-729-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005640Medicaid
NC2339728AMedicare PIN
NC2339728BMedicare PIN
NC2339728Medicare PIN