Healthcare Provider Details

I. General information

NPI: 1710165923
Provider Name (Legal Business Name): DAYBREAK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 S MILLS DR
EULESS TX
76040-5128
US

IV. Provider business mailing address

4800 OVERTON PLZ STE 440
FT WORTH TX
76109-4435
US

V. Phone/Fax

Practice location:
  • Phone: 817-355-9661
  • Fax:
Mailing address:
  • Phone: 817-447-2700
  • Fax: 817-447-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number001012228
License Number StateTX

VIII. Authorized Official

Name: ROBERT WOLIN
Title or Position: ATTORNEY
Credential:
Phone: 713-646-1327