=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174328991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAYSTAR SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2025
-----------------------------------------------------
Last Update Date | 04/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1159 COUNTY ROAD 411
-----------------------------------------------------
City | PROCTORVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45669-9409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-861-9171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4513 COUNTY ROAD 12
-----------------------------------------------------
City | PROCTORVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45669-8304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-861-9171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/DIRECTOR
-----------------------------------------------------
Name | TIMOTHY PORTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-744-8730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 347B00000X
-----------------------------------------------------
Taxonomy Name | Bus
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------