Healthcare Provider Details

I. General information

NPI: 1073534228
Provider Name (Legal Business Name): DAYBREAK YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 S COWLEY ST
SPOKANE WA
99202
US

IV. Provider business mailing address

960 E 3RD AVE
SPOKANE WA
99202-2241
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-3227
  • Fax: 509-459-3920
Mailing address:
  • Phone: 509-444-7033
  • Fax: 509-927-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number011601
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number011601
License Number StateWA

VIII. Authorized Official

Name: MR. THOMAS RUSSELL
Title or Position: CEO
Credential:
Phone: 509-444-7033