Healthcare Provider Details

I. General information

NPI: 1093701385
Provider Name (Legal Business Name): DAYBREAK NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/28/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 STATE HIGHWAY H
SIKESTON MO
63801-5350
US

IV. Provider business mailing address

410 STATE HIGHWAY H
SIKESTON MO
63801-5350
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-7683
  • Fax: 573-471-0519
Mailing address:
  • Phone: 573-471-7683
  • Fax: 573-471-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BEN PACK SELLS
Title or Position: CEO
Credential:
Phone: 573-614-7472