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General NPI Number Information
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NPI Number | 1164395638
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Entity Type | Organization
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Legal Business Name | DAYSTAR OLYMPIA ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 1015 ROCKCRESS DR SE
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City | OLYMPIA
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State | WA
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Zip | 98513-2147
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Country | US
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Telephone | 978-885-7422
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Fax |
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Provider Business Mailing Address
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Address Line | 111 CANDLEWYCK DR W
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City | LAKEWOOD
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State | WA
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Zip | 98499-8113
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Country | US
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Telephone | 978-885-7422
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Fax | 253-352-8099
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Authorized Official
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Title or Position | PROVIDER
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Name | PERIS MBARIA
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Credential | RN
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Telephone | 978-996-0081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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