1093856593 NPI number — DAYBREAK ADULT DAY SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093856593 NPI number — DAYBREAK ADULT DAY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAYBREAK ADULT DAY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093856593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6401 DOGWOOD RD STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21207-5248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-298-9800
Provider Business Mailing Address Fax Number:
410-298-5206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7819 ROCKY SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-2824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-696-0808
Provider Business Practice Location Address Fax Number:
301-696-1164
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEVADOSS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
CHAIRMAN OF THE BORAD
Authorized Official Telephone Number:
410-298-9800

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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