Healthcare Provider Details

I. General information

NPI: 1790120764
Provider Name (Legal Business Name): DAYBREAKS SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2013
Last Update Date: 05/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 MERCANTILE DR STE A
HIGHLAND IL
62249-1297
US

IV. Provider business mailing address

1308 MERCANTILE DR STE A
HIGHLAND IL
62249-1297
US

V. Phone/Fax

Practice location:
  • Phone: 618-651-4120
  • Fax: 618-651-4121
Mailing address:
  • Phone: 618-651-4120
  • Fax: 618-651-4121

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: CARLA MARIE RIVA
Title or Position: EXECUTIVE DIRECTOR
Credential: LPN
Phone: 618-651-4120