Provider Demographics
NPI:1558482919
Name:DAYSTAR YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:DAYSTAR YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:BIBEE
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-623-4105
Mailing Address - Street 1:528 BOONE RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-4906
Mailing Address - Country:US
Mailing Address - Phone:336-623-4105
Mailing Address - Fax:336-623-3999
Practice Address - Street 1:210 CEDAR ST
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5502
Practice Address - Country:US
Practice Address - Phone:336-623-8272
Practice Address - Fax:336-623-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 079-070322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children