Provider Demographics
NPI:1144933268
Name:EBENEZER DAYBREAK OF ST. PAUL
Entity type:Organization
Organization Name:EBENEZER DAYBREAK OF ST. PAUL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-874-3493
Mailing Address - Street 1:45 10TH ST W STE 3440
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1062
Mailing Address - Country:US
Mailing Address - Phone:651-328-4889
Mailing Address - Fax:
Practice Address - Street 1:45 10TH ST W STE 3440
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1062
Practice Address - Country:US
Practice Address - Phone:651-328-4889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EBENEZER SOCIETY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care