Provider Demographics
NPI:1164395638
Name:DAYSTAR OLYMPIA ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:DAYSTAR OLYMPIA ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PERIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MBARIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:978-996-0081
Mailing Address - Street 1:111 CANDLEWYCK DR W
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8113
Mailing Address - Country:US
Mailing Address - Phone:978-885-7422
Mailing Address - Fax:253-352-8099
Practice Address - Street 1:1015 ROCKCRESS DR SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-2147
Practice Address - Country:US
Practice Address - Phone:978-885-7422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty