Healthcare Provider Details

I. General information

NPI: 1699809384
Provider Name (Legal Business Name): DAYBREAK TREATMENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258-68 PINEDGE DR.
WEST BERLIN NJ
08091
US

IV. Provider business mailing address

P.O. BOX 2136
OCEAN NJ
07712
US

V. Phone/Fax

Practice location:
  • Phone: 856-753-8111
  • Fax: 856-753-3339
Mailing address:
  • Phone: 732-922-0591
  • Fax: 732-922-0593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number10020-02-05
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number10020-03-05
License Number StateNJ

VIII. Authorized Official

Name: MR. JEFFREY I. GOLDSTEIN
Title or Position: CEO
Credential: JD, MBA
Phone: 732-245-8473