Provider Demographics
NPI:1093701385
Name:DAYBREAK NURSING CENTER LLC
Entity Type:Organization
Organization Name:DAYBREAK NURSING CENTER LLC
Other - Org Name:DAYBREAK NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:PACK
Authorized Official - Last Name:SELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-614-7472
Mailing Address - Street 1:410 STATE HIGHWAY H
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5350
Mailing Address - Country:US
Mailing Address - Phone:573-471-7683
Mailing Address - Fax:573-471-0519
Practice Address - Street 1:410 STATE HIGHWAY H
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5350
Practice Address - Country:US
Practice Address - Phone:573-471-7683
Practice Address - Fax:573-471-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO050598OtherSTATE LICENSE
MO102114600Medicaid