Healthcare Provider Details

I. General information

NPI: 1699247726
Provider Name (Legal Business Name): DAYBREAK SENIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 VALLEY DR
OGDEN UT
84401-0847
US

IV. Provider business mailing address

2171 N 3900 W
PLAIN CITY UT
84404-9713
US

V. Phone/Fax

Practice location:
  • Phone: 801-823-0160
  • Fax:
Mailing address:
  • Phone: 801-230-7203
  • Fax:

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: JOHN AUGUST LARSSON
Title or Position: MANAGER
Credential:
Phone: 801-230-7203