=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336361633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAYSTAR RESIDENTIAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3926 BAHLER AVE
-----------------------------------------------------
City | MANVEL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77578-2823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-489-0317
-----------------------------------------------------
Fax | 281-489-1800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3926 BAHLER AVE
-----------------------------------------------------
City | MANVEL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77578-2823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-489-0317
-----------------------------------------------------
Fax | 281-489-1800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. CARROLL MORGAN SALLS
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 281-489-3054
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | 516827
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 322D00000X
-----------------------------------------------------
Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
-----------------------------------------------------
License Number | 516827
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------