Basic Information
| Provider Information | |||||||||
| NPI: | 1255874913 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAYMARK RECOVERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5841 US 421 S | ||||||||
| Address2: | |||||||||
| City: | LILLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275466713 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 5841 US 421 S | ||||||||
| Address2: | |||||||||
| City: | LILLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275466713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108935727 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2016 | ||||||||
| LastUpdateDate: | 11/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | TYSINGER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CENTER DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9108935727 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC, LCAS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305S00000X | 12716 | NC | Y | Managed Care Organizations | Point of Service |
No ID Information.