Healthcare Provider Details

I. General information

NPI: 1467026096
Provider Name (Legal Business Name): DAYMARK RECOVERY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 W ANDREWS AVE STE H
HENDERSON NC
27536-2562
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 252-433-0061
  • Fax: 252-433-0065
Mailing address:
  • Phone: 704-939-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. BILLY RAY WEST JR.
Title or Position: CEO
Credential: MSW,LCSW
Phone: 704-939-1133