Healthcare Provider Details

I. General information

NPI: 1720398498
Provider Name (Legal Business Name): DAYSTAR ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8461 CHALMERS AVE
WARREN MI
48089-2420
US

IV. Provider business mailing address

33833 GATES ST
CLINTON TOWNSHIP MI
48035-4210
US

V. Phone/Fax

Practice location:
  • Phone: 248-747-7417
  • Fax: 586-791-3567
Mailing address:
  • Phone: 248-747-7417
  • Fax: 586-791-3567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN HAMLETT
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 248-747-7417