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General NPI Number Information
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NPI Number | 1073534228
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Entity Type | Organization
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Legal Business Name | DAYBREAK YOUTH SERVICES
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 628 S COWLEY ST
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City | SPOKANE
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State | WA
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Zip | 99202
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Country | US
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Telephone | 509-624-3227
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Fax | 509-459-3920
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Provider Business Mailing Address
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Address Line | 960 E 3RD AVE
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City | SPOKANE
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State | WA
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Zip | 99202-2241
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Country | US
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Telephone | 509-444-7033
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Fax | 509-927-1851
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Authorized Official
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Title or Position | CEO
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Name | MR. THOMAS RUSSELL
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Credential |
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Telephone | 509-444-7033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 011601
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 011601
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License Number State | WA
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