Provider Demographics
NPI:1043427701
Name:DAY BREAK AT WATERBURY, LLC
Entity Type:Organization
Organization Name:DAY BREAK AT WATERBURY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:REPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-757-0106
Mailing Address - Street 1:161 INTERSTATE LANE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705
Mailing Address - Country:US
Mailing Address - Phone:203-757-0106
Mailing Address - Fax:203-596-9264
Practice Address - Street 1:161 INTERSTATE LANE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705
Practice Address - Country:US
Practice Address - Phone:203-757-0106
Practice Address - Fax:203-596-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care