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Daymark Recovery Services Inc

Organization Active NPI Psychiatry Physician · Winston Salem, NC

NPI 1104034883 · NPPES record last updated Aug 16, 2023

Key facts

NPI
1104034883
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
Legal business name
DAYMARK RECOVERY SERVICES INC
Practice address
650 Highland Ave Ste 110
Winston Salem, NC 27101-4367
Phone
(333) 660-7852
Fax
(336) 773-0916
NPI assigned
May 18, 2007
Organization subpart
No

Authorized official

Name
Mr. Billy R West Jr., L.C.S.W.
Title
President
Phone
(704) 939-1100

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Daymark Recovery Services (190 organizations share this tax ID)

Locations

650 Highland Ave
Ste 100
Winston Salem, NC 27101
Phone (336) 606-8523

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 2084P0800X Yes

Addresses

Primary practice location

650 Highland Ave Ste 110
Winston Salem, NC 27101-4367

Mailing address

284 Executive Park Drive
Suite 100
Concord, NC 28025-1894
Phone (704) 939-1100

Other identifiers

IdentifierTypeStateIssuer
5902072MedicaidNC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 16, 2023.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692144000000",
    "number": "1104034883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 EXECUTIVE PARK DRIVE",
            "address_2": "SUITE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251894",
            "telephone_number": "704-939-1100",
            "fax_number": "704-939-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HIGHLAND AVE STE 110",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271014367",
            "telephone_number": "333-660-7852",
            "fax_number": "336-773-0916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAYMARK RECOVERY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A",
        "authorized_official_last_name": "WEST",
        "authorized_official_first_name": "BILLY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-939-1100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "L.C.S.W."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902072",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

All providers in Winston Salem, NC · Psychiatry Physician in North Carolina

Sources for this page

Verify at the official NPI Registry.