Provider Demographics
NPI:1174664650
Name:DAYBREAK ADULT DAYCARE
Entity Type:Organization
Organization Name:DAYBREAK ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ILLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-353-3530
Mailing Address - Street 1:712 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3540
Mailing Address - Country:US
Mailing Address - Phone:908-353-3530
Mailing Address - Fax:908-353-3529
Practice Address - Street 1:712 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3540
Practice Address - Country:US
Practice Address - Phone:908-353-3530
Practice Address - Fax:908-353-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ908113261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0009105Medicaid