Provider Demographics
NPI:1811105596
Name:DAYMARK RECOVERY SERVICES INC
Entity type:Organization
Organization Name:DAYMARK RECOVERY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IS ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEST
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-939-1100
Mailing Address - Street 1:284 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1894
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:741 SPAINHOUR RD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9393
Practice Address - Country:US
Practice Address - Phone:336-985-0625
Practice Address - Fax:336-985-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902071Medicaid
NC2339728Medicare PIN