Healthcare Provider Details

I. General information

NPI: 1982063384
Provider Name (Legal Business Name): DAYMARK RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1831
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1831
US

V. Phone/Fax

Practice location:
  • Phone: 704-939-1100
  • Fax: 704-939-1173
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number233781
License Number StateNC

VIII. Authorized Official

Name: LYNN MENA
Title or Position: CREDENTIALIND SPECIALIST
Credential:
Phone: 704-939-1118