Healthcare Provider Details

I. General information

NPI: 1134078512
Provider Name (Legal Business Name): DAYSON DIAMOND YOUTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 SUTTLE ST
SHELBY NC
28150-4533
US

IV. Provider business mailing address

404 SUTTLE ST
SHELBY NC
28150-4533
US

V. Phone/Fax

Practice location:
  • Phone: 704-406-9973
  • Fax:
Mailing address:
  • Phone: 704-406-9973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRYL DAYSON
Title or Position: OWNER
Credential:
Phone: 704-668-7449