Provider Demographics
NPI:1639344708
Name:DAYMARK INC
Entity Type:Organization
Organization Name:DAYMARK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEASE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-340-3675
Mailing Address - Street 1:1592 WASHINGTON STREET EAST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311
Mailing Address - Country:US
Mailing Address - Phone:304-340-3675
Mailing Address - Fax:340-340-3595
Practice Address - Street 1:1592 WASHINGTON STREET EAST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311
Practice Address - Country:US
Practice Address - Phone:304-340-3595
Practice Address - Fax:304-340-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV191 AND 192322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children