Healthcare Provider Details

I. General information

NPI: 1043427701
Provider Name (Legal Business Name): DAY BREAK AT WATERBURY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 INTERSTATE LANE
WATERBURY CT
06705
US

IV. Provider business mailing address

161 INTERSTATE LANE
WATERBURY CT
06705
US

V. Phone/Fax

Practice location:
  • Phone: 203-757-0106
  • Fax: 203-596-9264
Mailing address:
  • Phone: 203-757-0106
  • Fax: 203-596-9264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. REPHAEL MAX
Title or Position: COO
Credential:
Phone: 203-757-0106