Provider Demographics
NPI:1720398498
Name:DAYSTAR ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:DAYSTAR ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-747-7417
Mailing Address - Street 1:33833 GATES ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4210
Mailing Address - Country:US
Mailing Address - Phone:248-747-7417
Mailing Address - Fax:586-791-3567
Practice Address - Street 1:8461 CHALMERS AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2420
Practice Address - Country:US
Practice Address - Phone:248-747-7417
Practice Address - Fax:586-791-3567
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAYSTAR ASSISTED LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care