MEDICARE: DAYBREAK FAMILY SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1770818544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYBREAK FAMILY SERVICES

Provider Business Mailing Address
First Line	:	1516 S BOSTON AVE
Second Line	:	SUITE 100
City	:	TULSA
State	:	OK
Zip	:	74119-4003
Country	:	US
Telephone Number	:	918-561-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 S BOSTON AVE
Second Line	:	SUITE 100
City	:	TULSA
State	:	OK
Zip	:	74119-4003
Country	:	US
Telephone Number	:	918-561-6001
Fax Number	:

Authorized Official
Title or Position	:	REHAB SPECIALIST
Name	:	EMILY ROSE DE DONATO
Credential	:
Telephone Number	:	918-340-6174

Provider Enumeration Date	:	10/12/2009
Last Update Date	:	02/02/2010

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