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General NPI Number Information
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NPI Number | 1639344708
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Entity Type | Organization
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Legal Business Name | DAYMARK INC
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 1592 WASHINGTON STREET EAST SUITE 2
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City | CHARLESTON
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State | WV
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Zip | 25311
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Country | US
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Telephone | 304-340-3595
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Fax | 304-340-3595
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Provider Business Mailing Address
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Address Line | 1592 WASHINGTON STREET EAST SUITE 2
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City | CHARLESTON
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State | WV
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Zip | 25311
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Country | US
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Telephone | 304-340-3675
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Fax | 340-340-3595
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DENNIS PEASE
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Credential | MA
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Telephone | 304-340-3675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 191 AND 192
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License Number State | WV
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