MEDICARE: DAYBREAK TRANSPORTATION SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1629696315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYBREAK TRANSPORTATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	26261 MAIN ST STE 2
Second Line	:
City	:	COOLVILLE
State	:	OH
Zip	:	45723-9205
Country	:	US
Telephone Number	:	740-415-1138
Fax Number	:	201-661-2846

Provider Business Practice Location Address
First Line	:	26261 MAIN ST STE 2
Second Line	:
City	:	COOLVILLE
State	:	OH
Zip	:	45723-9205
Country	:	US
Telephone Number	:	740-415-1138
Fax Number	:	201-661-2846

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRYAN CASEY
Credential	:
Telephone Number	:	740-415-1138

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	07/08/2020

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