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General NPI Number Information
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NPI Number | 1588065791
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Entity Type | Organization
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Legal Business Name | DAYBREAK
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Dates
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Enumeration Date | 09/07/2014
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Last Update Date | 09/07/2014
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Provider Practice Location Address
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Address Line | 4431 CATALINA CIR
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City | EAST POINT
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State | GA
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Zip | 30344-6510
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Country | US
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Telephone | 404-437-1509
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Fax |
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Provider Business Mailing Address
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Address Line | 4431 CATALINA CIR
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City | EAST POINT
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State | GA
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Zip | 30344-6510
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Country | US
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Telephone | 404-437-1509
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATHAN RENEE PHILLIPS
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Credential |
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Telephone | 404-437-1509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 056-R-1306
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License Number State | GA
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