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General NPI Number Information
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NPI Number | 1184096950
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Entity Type | Organization
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Legal Business Name | DAYSTARS ADULT ACTIVITIES CENTER, INC
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 11/12/2023
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Provider Practice Location Address
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Address Line | 4611 S MAIN ST STE 8
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City | STAFFORD
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State | TX
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Zip | 77477-4731
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Country | US
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Telephone | 346-754-3490
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Fax | 832-532-7236
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Provider Business Mailing Address
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Address Line | 4611 S MAIN ST STE 8
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City | STAFFORD
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State | TX
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Zip | 77477-4731
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Country | US
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Telephone | 346-754-3490
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Fax | 832-532-7236
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | SHANTERIA ONYEMEM
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Credential | LPC
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Telephone | 346-754-3490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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