Provider Demographics
NPI:1467205294
Name:DAYLIGHT RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:DAYLIGHT RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:BANOGE
Authorized Official - Last Name:GISORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-373-1189
Mailing Address - Street 1:629 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6848
Mailing Address - Country:US
Mailing Address - Phone:682-373-1189
Mailing Address - Fax:
Practice Address - Street 1:629 MAIN ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6848
Practice Address - Country:US
Practice Address - Phone:682-373-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities