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Daymark Recovery Services Inc

Organization Active NPI Psychiatry Physician · Monroe, NC

NPI 1720296403 · NPPES record last updated Jun 21, 2023

Key facts

NPI
1720296403
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
Legal business name
DAYMARK RECOVERY SERVICES INC
Practice address
701 W Roosevelt Blvd
Ste 600
Monroe, NC 28112-4106
Phone
(704) 296-6200
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.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

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

Specialties & licenses

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

Addresses

Primary practice location

701 W Roosevelt Blvd
Ste 600
Monroe, NC 28112-4106

Mailing address

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

Other practice location 1

1190 W Roosevelt Blvd
Monroe, NC 28110-2818
Phone (704) 296-6200

Other identifiers

IdentifierTypeStateIssuer
5900904MedicaidNC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 21, 2023.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1720296403",
    "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": "CANNON",
            "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": "701 W ROOSEVELT BLVD",
            "address_2": "STE 600",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281124106",
            "telephone_number": "704-296-6200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1190 W Roosevelt Blvd",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "NC",
            "postal_code": "281102818",
            "country_code": "US",
            "telephone_number": "704-296-6200",
            "fax_number": "704-296-4668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DAYMARK RECOVERY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2023-06-21",
        "certification_date": "2023-04-19",
        "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": "5900904",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, NC

All providers in Monroe, NC · Psychiatry Physician in North Carolina

Sources for this page

Verify at the official NPI Registry.