Provider Demographics
NPI:1275658825
Name:DAY BREAK ADULT DAY CARE SERVICES, INC.
Entity Type:Organization
Organization Name:DAY BREAK ADULT DAY CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORA
Authorized Official - Middle Name:PEEBLES
Authorized Official - Last Name:MATTOCKS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:252-527-6882
Mailing Address - Street 1:517 N QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-4329
Mailing Address - Country:US
Mailing Address - Phone:252-527-6882
Mailing Address - Fax:252-527-9447
Practice Address - Street 1:517 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-4329
Practice Address - Country:US
Practice Address - Phone:252-527-6882
Practice Address - Fax:252-527-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409374Medicaid