Provider Demographics
NPI:1104974203
Name:DAISY'S WAY
Entity type:Organization
Organization Name:DAISY'S WAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DW
Authorized Official - Last Name:JACKO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-254-2602
Mailing Address - Street 1:363 CLIFTON STREET SUITE 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:27858
Mailing Address - Country:US
Mailing Address - Phone:252-347-1095
Mailing Address - Fax:
Practice Address - Street 1:363 CLIFTON STREET SUITE 4
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:CA
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-347-1095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health