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General NPI Number Information
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NPI Number | 1750601795
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Entity Type | Organization
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Legal Business Name | DAYBREAK CANYON
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 06/01/2010
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Provider Practice Location Address
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Address Line | 275 E 1600 N
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City | RUPERT
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State | ID
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Zip | 83350-9563
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Country | US
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Telephone | 208-312-4117
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Fax | 877-580-3806
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Provider Business Mailing Address
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Address Line | PO BOX 348
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City | TWIN FALLS
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State | ID
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Zip | 83303-0348
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Country | US
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Telephone | 208-655-4111
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Fax | 877-580-3806
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Authorized Official
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Title or Position | FOUNDER, CEO
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Name | MR. LARRY MCARTHUR
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Credential |
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Telephone | 208-312-4117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 28990
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License Number State | ID
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