Healthcare Provider Details

I. General information

NPI: 1881878460
Provider Name (Legal Business Name): DAYBREAK BEHAVIORAL RESOURCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6070 E TREADWAY TRL
FLAGSTAFF AZ
86004-1029
US

IV. Provider business mailing address

6070 E TREADWAY TRL
FLAGSTAFF AZ
86004-1029
US

V. Phone/Fax

Practice location:
  • Phone: 928-526-1499
  • Fax: 928-526-1151
Mailing address:
  • Phone: 928-526-1499
  • Fax: 928-526-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberDDH1715
License Number StateAZ

VIII. Authorized Official

Name: MR. THOMAS W KENNY
Title or Position: CEO
Credential:
Phone: 928-526-0779