MEDICARE: DAYBREAK, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1306446000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYBREAK, INC.

Provider Business Mailing Address
First Line	:	4800 OVERTON PLZ STE 440
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4435
Country	:	US
Telephone Number	:	800-299-5161
Fax Number	:

Provider Business Practice Location Address
First Line	:	6520 BRADDOCK PL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-2902
Country	:	US
Telephone Number	:	800-299-5161
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS BUSINESS MANAGER
Name	:	ANNA TODD
Credential	:
Telephone Number	:	800-299-5161

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/30/2020

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Directions to “DAYBREAK, INC. ” Practice Location

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